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LAND USE PERMIT APPLICATION — Burnett Countv, WI <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure <br />$300 <br />Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure <br />$300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) <br />$150 <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) <br />$200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Driveways/ & Campground Structures <br />$125 <br />Bunkhouse <br />WI State Statute 59.692(1v) Structures <br />$250 <br />$350 <br />Filling/Grading <br />$150 <br />Boathouse <br />$500 <br />1$1001 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />Permit Extension (1 Year Extension - Allowed Once) <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: —L& U e ¢' <br />Property Owner's Mailing Address: a <br />Property Site Address: ip 0 <br />n —L Tj o r '� <br />ec) fio5��,1 <br />State <br />Gti <br />° 5Y <br />Zip <br />Contact's Telephone Number: CQ �//Z $ �P roc -2 % p <br />Contact's Email: bi�Jr 6 r t` q Pin CL <br />Legal Description of Property: �c I 6 L <br />Section #: 169 Town #:��N Range #:-IY W Town of u s <br />*Attach additionalpage if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br />Tax ID # (1-5 digit number; found on tax statement): /6-7-7 <br />Proposed Use of Structure/Addition: 5bC".- 5 'Q' �/ f <br />Anticipated Start Date: (Q ^ 2 0 — � $ (Home/Cabin; Commercial Business,, Bedr Deck; etc.) <br />Building Contractor: -6 k" e 6 cwt H 'e r Sewer Installer: P /o <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />4J- -Ax1- <br />A <br />.. o <br />1 A Date of staff site visit I Q Initials of si visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIA 44DA <br />a"a// <br />UPON APPROVAL: APPLICANT MUrST 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 />n <br />Cn <br />=" <br />::� I I <br />Fee Rec: /337,� <br />Check #: ! , - <br />'?347 <br />0 <br />i <br />.a <br />N <br />C:? <br />co <br />