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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 appropriai <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 Camping Unit (One Per Ye <br />$300 <br />Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />$300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />v. <br />$150 <br />Addition/Alteration to Accessory Structure <br />$150 <br />5 <br />$200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />%e%% <br />Bunkhouse <br />$250 <br />$125 <br />WlState Statute 59.692(lv)Structures <br />$350 <br />Q <br />$150 <br />lBoathouse <br />$500 <br />$100 <br />1 Permit Extension (1 Year Extension - Allowed Once) <br />$100 <br />_ <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 occessory structures, such as: peraolas, landscaoina, etc. <br />Property Owner's Name: 1 V r Sr <br />a �- <br />Property Owner's Mailing Address: <br />Property Site Address:��� <br />Contact's Telephone Number: (o - a,6 5 i" <br />Contact's Email: {%1 It �- Cw —toy k H t5 <br />Legal Description of Property: <br />Section #: Town #: N Range #: W Town of: <br />o <br />City State Zip <br />/f <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): `-f b 0 / Cf - ,5 Is l - �16 p - 0"T C)5c) <br />//3 i <br />Proposed Use of Stnicture/Ad ition• C.�G( b' G�'.- U .e S = <br />Anticipated Start Date: J aif oz % B (H e/Cabin: Commercial Business; Bedroom; Deck; etc.) <br />JJ,^ <br />Building Contractor: P57t Y ,(j %off A- f�dl <br />Sewer Installer: C�' 200 Sinal , <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLYd�� <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />10'1 e -e-- f © S eW eye: /c-- 7e, --,S E� C <br />/ y <br />1713 112 -ale. <br />d 30 � <br />Date of staff site visit: fInitials of ' e vis' -staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL, DATE: <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 />c <br />C'} <br />z <br />61 <br />VA <br />mm <br />1V <br />o <br />y Fee Rec: <br />x <br />Check #: <br />0 <br />m <br />a E- ,AIR <br />- m <br />Q0 C=I <br />n O CLV <br />to co <br />< rj <br />m pUU <br />0 <br />a <br />b <br />