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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 $300 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: <br />Property Owner's Mailing Address: �J r thn <br />/ City State Zip <br />Property Site Address: 9 0 3 (O N p r41 ,, , �o Q �� <br />Contact's Telephone Number: (� I Z 2 F-6 2 7 7 <br />Contact's Email: �O IQS O 6 1( F7 K ✓%'1 Q c <br />Legal Description of Property: P,a r C e- r% L b <br />Section #: J Town #:--3 c N Range #:-'W Town of R U S <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br />Tax ID # (1-5 digit number; found on tax statement): t S' % _% ),— <br />Proposed Use of Structure/Addition: D $ L k <br />Anticipated Start Date: Zo 1 g (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: r Sewer Installer: �//4 <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Date of staff site visit: Initials ofsit visit staff: <br />�p <br />PERMIT APPROVED BY LAND SERVICES OFFICI D TO 1� / Q <br />UPON APPROVAL: APPLICANT 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 />c <br />0 <br />a <br />0 <br />0 <br />ro <br />S' <br />0 <br />a <br />rz <br />0 <br />m <br />a <br />G7 <br />ao <br />,4 <br />d <br />d <br />W <br />Fee Rec: D'S <br />Check #: l <br />