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LAND USE PERMIT APPLICATION - Burnett County, WI 9: <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 AccessoryStructure <br />$150 <br />AccessoryStructure (CommerciaUlndustrial <br />$200 <br />Addition/ Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/ Sidewalk <br />Driveways/ &Campground Structures <br />$125 1 <br />Bunkhouse <br />IWI State Statute 59.692(ly) Structures <br />$250 <br />$350 <br />Filling/Grading <br />$150 <br />1$1001 <br />113oathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />Permit Fxtension (1 Year Extension - Allowed Once) <br />$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 willbe treated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name <br />L OU iHt, E, L i JSicss 1 -1.414 - <br />Property Owner's Mailing Address: <br />Property Site Address: 0 U 3S <br />Contact's Telephone Number: <br />11(l k.Jt,�Av�Lti UVd Lme— Goliea.V4 <br />F;K�ti�e— <br />�- City <br />�1�. dSv—ldl3 <br />State Zip <br />Contact's Email: CI L° I �%we-&S ® ht 14 4 o &- CTVdvt • C0 � <br />Legal Description of Property: '�eLc'3 L A—e <br />Section #: Town #: N Range #: W Town of: <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): 14 19R, <br />Proposed Use of Structure/Addition: Rt jzceB ckvrt.,-� wood w r%- IrOG(L <br />Anticipated Start Date: e k d 04-' � gu l 46 (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: X14ih ftj Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />0-n 1� \'JOA, a- � I ic�\,j "-K k <br />s <br />\C �A\aw� <br />Date of staff site visit: <br />10 hio/ 1.2 <br />PERMIT APPROVED BY LAND SERVICES <br />UPON APPROVAL: APP <br />Initials of site visit staff: <br />EICI 4DAT <br />T 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 />LA <br />G <br />�E w <br />x <br />a C7 <br />O `~ Oct <br />-t- <br />z <br />Fee Rec: <br />Check #: Soo <br />0 <br />1 <br />co <br />N <br />CD <br />co <br />