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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 appropria <br />Dwelling/Principal Structure <br />Commercial/Industrial Structure <br />Accessory Structure (Ga hed, et !) <br />Accessory Structure (d0ndustrial <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Driveways/ & Campground Structures <br />Filling/Grading <br />Six Month Camping Unit (One Per Year) <br />$300 <br />Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />$300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />$150 <br />Addition/Alteration to Accessory Structure <br />$150 <br />$200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />Bunkhouse <br />$250 <br />$125 <br />WlState Statute 59.692(ly) Structures <br />$350 <br />$150 <br />Boathouse <br />$500 <br />5100 <br />Permit Extension (1 Year Extension - Allowed Once) <br />$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: �" I t Y k- PkI-s-e\1 <br />Property Owner's Mailing Address: <br />Property Site Address: <br />D C �4 / ( - A -V -P,- c P, -j --E <br />City State <br />/0 <br />Zip <br />Contact's Telephone Number: �95� �' •, <br />Contact's Email: fn 61- j� �L 4' �'Sy� 1 ' "111711 •71«-I2'�j~' o=G`17� <br />Legal a1 DeSC; i,.r:.,,, --fPro <br />G� S r� " /O )Wr�JS'fS�e,ar Div <br />Section #:� Town #:N Range #:� W Town of: /%� /� (� K Cz <br />*Attach additional page if neededfor 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? <br />Proposed Use of Stricture/Addition; r <br />Anticipated Start Date: ATP ^ me/Cabnr Commercial Business; Bedroom; Deck; etc) <br />Building Contractor: —k - ✓p"( 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 />k,� <br />L , t <br />O VI U�C <br />Date of staff site visit: ( Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIA r ?, DAT : <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: - Pagel of 4 <br />Laserfische: - Burnett County, WI Land Use Application — Rev 8/2018 <br />Fee Rec: <br />Check #: 349-5-3 <br />0 <br />m <br />