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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 jWl State Statute 59.692(ly) Structures $350 <br />Filling/Grading $150 lBoathouse $500 <br />Six Month Camping Unit (One Per Year) $100 jPermit Extension (1 Year Extension - Allowed Once) 1$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: �64k 4— &fw-7- 6 �O�IN-Sc�✓'� <br />Property Owner's Mailing Address: ,?6c -lo 4c) Ft " /Lf.£," RJ 5 0 01 SY 161 <br />City State Zip <br />Property Site Address: L) F#!�, e its <br />Contact's Telephone Number: -7 <br />Contact's Email: <br />Legal Description of Property: <br />Section #:_/ Town #:__ -3 _N Range #:1W Town of: RJS lc <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): /5 7 $ 7 <br />Proposed Use of Structure/Addition: SCA <br />Anticipated Start Date: Ne., l (Home/Cabin: Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: /Uy,i4-� L6j 1�� rte s &LAj.5 Sewer Installer: 2 j O fA�( O <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: J I Initials of site visit staff- �I <br />0/ <br />PERMIT PERMIT APPROVED BY LAND SERVICES OFFICIA� DATE: <br />UPON APPROVAL: APPLICANT ST 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 />Fee Rec:' <br />Check <br />e u wY) sr j— <br />r <br />o <br />1 <br />v <br />0 <br />co <br />YOU <br />