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1 <br />LAND USE PERMIT APPLICATION — Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check approprial <br />Dwelling/Principal Structure <br />Commercial/Industrial Structure <br />Accessory Structure (Garage, Shed, etc.) <br />Accessory Structure (Commercial/Industrial <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Driveways/ & Campground Structures <br />Filling/Grading <br />Six Month Campine Unit (One Per Yearl <br />300 Addition/Alteration to Dwelling/Principal Structure <br />300 Addition/Alteration to Commercial/Industrial Structure <br />150 Addition/Alteration to Accessory Structure <br />200 Addition/Alteration to Bunkhouse <br />Bunkhouse <br />125 WI State Statute 59.692(ly) Structures <br />150 Boathouse <br />100 IPermit 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: <br />Property Owner's Mailing Address: <br />Sso <br />City <br />> a l S <br />Property Site Address: s 2 p v�7 <br />Contact's Telephone Number: (m 'sem 1- 03 �— 7 1 1 <br />Contact's Email: <br />6 si <br />State Zip <br />Legal Description of Property: ry2 lai-7 Add. Ly - <br />Section #: Town #:--40 N Range #: l W Town of: <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 taty statement): �9Z� <br />Proposed Use of Structure/Addition. a��i <br />Anticipated Start Date: (Home/Cabin; Commercial Business; Bedroom; Deck; etc) <br />Building Contractor: 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 />i <br />Date of staff site visit: Initials of to visit staff <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL - <br />. <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 />b <br />ro <br />:� I I <br />Fee Rec: 0�- /o 0 <br />Check #: S .1 <br />5/ly = r U <br />CD <br />ry <br />0 <br />co <br />