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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 I 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 1 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: ` TTE0CAIfLi o o d`�F•�'�1!9.R j%� L <br />Property Owner's Mailing Address: 94--71 PO)}rt' in t -A-4 P- <br />2 <br />- <br />Z3 803 RETy-p— t% � S 1 aW Stat Z' <br />Ludt s <br />Property Site Address: <br />Contact's Telephone Number: 4D —%­�--3 Zkal <br />Contact's Email: <br />Legal Description of Property: L)- " (� � I V2J-,- P z27 <br />Section #: Town # f N Range #: W Town of. �h i <br />*Attach additional page if needed or engthy description OR attach a copy of the deed OR attach tax system propertypage. <br />Tax ID # (1-5 digit number; found on tax statement): <br />Proposed Use of Stricture/Addition: 5TDOW 15 <br />Anticipated Start Date: P Of IiF 201(Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: VfV4-u•'A-1 BU11-49F 1. , 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 />APPROVED '0r <br />Date of staff site visit: A0 - f 7 - O Initials of siisit staf <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: la&DATE: /D-/7` <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 />Fee Rec: <br />Check #. f� <br />e <br />z <br />NZ <br />0zrill <br />z <br />L�Q� <br />< <br />GO <br />i <br />