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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 f$200 <br />Addition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure Addition/Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) Addition/Alteration to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) Addition/Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/SidewalkBunkhouse $250 <br />Driveways/ & Campground Structures WI State Statute 59.692(iv) Structures $350 <br />Filling/Grading Boathouse $500 <br />Six Month Camping Unit (One Per Year) 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:__ <br />Property Owner's Mailing Address: �>L �G ✓ yi� OGS �r t.>d,4 ,' ``A �elk d <br />City State Zip <br />Property Site Address: e Y►'' J / <br />Contact's Telephone <br />/jNumber:G.0 s �� 67U% <br />Contact's Email: Yl �, Gi L✓1C Crj / �j/C� U ✓ E e_,_zj, / <br />Legal Description of PYgipe.�t,. iC q <br />Section #: �_ Town #: Q N Range #: W Town of: <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. j <br />Tax ID # (1-5 digit number; found on tax statement): C q 0,5 <br />Proposed Use of Stricture/Ad ition:ae" <br />4 <br />+) , e -- n <br />,f r �5 � I <br />Anticipated Start C)r I/ (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: r(fi'1Ste J t �) 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: Initials of sitf visit 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 />T <br />m <br />0 <br />0 <br />w <br />N <br />0 <br />C" <br />b <br />r=+ <br />0 <br />w <br />x <br />d <br />W <br />D <br />V <br />Fee Rec: 50 <br />Check #: <br />