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d <br />LAND USE PERMIT APPLICATION — Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please,- check apnrnnrinty boxed <br />Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br />AccessoryStructure Garage, Shed, etc.) $150 Addition/Alteration to Accessory Structure $150 <br />AccessoryStructure (Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(1v) Structures $350 <br />Filling/Grading $150 Boathouse $500 <br />Six Month Camping Unit (One Per Year) $100 Permit Eztensicn. (1 Year Extensi^:^. _ l:!!^;•,ed Once) $1N <br />*NOTE: After -the -fact permits (permit aqui red 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: , �U C- S1 104/v li rell 5z azt /)j/,,) 55�� <br />City State Zip <br />Property Site Address: , Y S % C6, 4P I 412C -65 6Q< �c�y • S Y 5' % j <br />Contact's Telephone Number: <br />/1,2z - <br />Contact's Email: 11 !✓ f��6�) �& <br />Legal Description of Property: e; <br />Section #:_ Town #: N Rangc #: W TowT, a; <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): ci t 7 I l <br />Proposed Use of Structure/Addition: AP4;, L /v%��'cc-%�'/i�e— s' n Jt S'I <br />Anticipated Start Date: 51141/1'C o26I / (Hom Cabin)Commercial Business; Bedroo eck; 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 />6,�,�9-,�,�Y, uS�,- ( of � �11<�4L <br />n <br />^ <br />Date of staff site visit: I Initials of sit visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL D TE: <br />UPON APPROVAL: APPLICANT m POST COP V 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 />b <br />CL <br />C7 <br />M <br />CD <br />00, <br />�I <br />Q <br />(° <br />o r <br />n W <br />Q N <br />g <br />e: <br />ao <br />l,J G� <br />o � <br />, ^ d <br />-� V ` <br />S --D <br />z <br />x <br />Fee Rec#,� Qo <br />Check #: I TI L <br />r- <br />CLCO Z <br />m W C) <br />a a N <br />CD <br />NC= <br />00 <br />CD 3 ' <br />o <br />M <br />