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LAND USE PERMIT APPLICATION - Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure Addition/Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) $150 Addition/Alteration to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(1v) Structures $350 <br />Filling/Grading 150 Boathouse $500 <br />Six Month Camping Unit (One Per Year) $100 Permit Extension (1 Year Extension - Allowed Once) $100 <br />*NOTE: After -the -fact permits (permit aquired after construction has begun) may cost up to three times the normal fee. <br />*Communication Towers & Signs require a different application form, see corresponding application, and fees. <br />*Items not listed above will be treated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: IM 6K I� J D <br />Property Owner's Mailing Address:` ( A h 5� ��+�/� "/ <br />Cityc- <br />State ZiProperty Site Address: 111 SYS 5010JO L 1� ��• W1 5`550937, <br />Contact's Telephone Number: 6C -1`4A �G (, �Y -71 S 5/G 0 770 7 <br />Contact's Email:U( u"Oti /` $ ,�'f <br />Legal Description of Property: C,011 t L f -2 J+ LOT <br />Section #: Town #:__&e N Range #:_ S W Town of: <br />*Attach additional page if needed for lengthy description OR attac/ha copy <br />of the deed OR attach tax system property page. <br />` q <br />Tax ID # (1-5 digit number; found on tax statement): 3 I I E3 <br />Proposed Use of Structure/Addition: Gyqpwe <br />Anticipated Start Date: tO6 <br />Q (Ho /Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: \/UQ jh'j W<, I JC Sewer Installer: lVdAle <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED <br />/BELOW: <br />GaYaG?i �115 �e GT /FA <br />a 1 <br />1,-,[ <br />e-0 (A <br />V e� �f--42;,k7 I,cp is vr..5,74V V-e—<T1- CIA <br />Date of staff site visit: Initials of site visit staff: q <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: <br />UPON APPROVAL: APPLICA T MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: - Page 1 of 4 <br />Laserfische: - Burnett County, WI Land Use Application — Rev 8/2018 <br />c <br />CL <br />CL <br />in <br />0 <br />N <br />0 <br />0 <br />5' <br />ao <br />C7 <br />0 <br />r <br />0 <br />r <br />0 <br />0 <br />ro <br />CD <br />a. <br />d <br />CD <br />WX <br />1 <br />C.� <br />a <br />C' <br />r:+ <br />o <br />� <br />H <br />w <br />P <br />CA3 <br />z <br />o <br />� <br />Coa <br />� <br />� <br />rn <br />W <br />G <br />ti Fee Rec:" /,SO <br />x <br />Check #: J7q3 <br />G Woo& Worrs 6LZw 5 <br />LLC <br />