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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 d$200 <br />Addition/Alteration to Dwell in Principal Structure $200 <br />Commercial/Industrial Structure Addition/Alteration to Commercial/Industrial Structure $200 <br />AccessoryStructure (Garage, Shed, etc. Addition/Alteration to AccessoryStructure $150 <br />Accessory Structure (Commercial/Industrial) Addition/Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(lv) 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: J, A :) �1 , , Ly-►� . rr ynn}n Lik—r- <br />Property Owner's Mailing Address: 1 p <br />/� <br />} City State Zip <br />Property Site Address:&� i L).A t W 1 � <br />��� A '613 <br />Contact's Telephone Number: <br />Contact's Email: S6 Ci f.L) 11)( YY1C� i L t C wt (0.1 bZ4 ( mas 307' <br />w�+M, F -44T 3f 3q'1a5S <br />Legal Description of Property: �_c 2 n 4e) iS' 2. GSI U 14 f Vlo (2 ?"vi I,) <br />Section #: _ Town #:_40__N Range #:_/ 5- W Town of: JGL-CA� <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)`: 15-�0 7 <br />Proposed Use of Structure/Addition: Sf l J OX <br />Anticipated Start Date: p j101 (Home%Cabin; Conunercial Business; Bedroom: Deck; etc.) <br />Building Contractor:-z1lS5?i1'S �'_ 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 />Date of staff site visit: O ' Initials of site visit staff., <br />� � L Ov� 2Y' 4 <br />PERIMi APPROVED By LA:VUSERVICES Orrit-lit Y"" � DAIa(: / <br />UPON APPROVAL: APPLICA./NT 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 />N <br />0 <br />0 <br />5' <br />�o <br />d <br />U. <br />n <br />3 <br />G <br />S <br />0 <br />z <br />A <br />(r <br />N <br />c <br />a. <br />v <br />0-- <br />001 <br />ig <br />0 6.0 <br />to <br />S <br />r <br />b <br />00 <br />J <br />i <br />X <br />0 <br />Fee Rec: <br />►so°o <br />Check #: / D 0 7 <br />0 <br />C-) <br />N <br />N <br />0 <br />00 <br />