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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 $300 Addition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) $150 Addition/Alteration to Accessory Structure $150 <br />Accessory Structure (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(ly) Structures $350 <br />Filling/Grading $150 Boathouse Issoo <br />Six Month Camping Unit (One Per Year) $100 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: --2 To I I C1 N de.� <br />Property Owner's Mailing Address:/ -1 4--;-7 A' IV Z- <br />Z 7,Zzo fal City State Zip <br />Property Site Address: � ,/c�tfi% ��7(';yr\( <br />Contact's Telephone Number: 71 ,2-zt1;, - /O1- 7- <br />Contact's Email: /0 1- 7C9 /0 06:c <br />L, - g--! DescriYt.i.on.. of Property: Pcz <br />D i <br />Section #: TJ I Town #: -7L' N Range #: %� W Town of: (!�7 0ti iv <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):/// 3, i?)j `J <br />Proposed Use of Stnicture/Addition: �,,Jxd E1 T. <br />Anticipated Start Date: (Home/Cabin; Commercial Business; Bedroont; Deck; etc.) J <br />Building Contractor: j (' l Sewer Installer: AAjo f Ilj'7 <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Sfo rrxci e U 15e, O`wZ� f <br />APPROVED <br />Date of staff site visit: le Initials of ke isit s ff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: Af-ff 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 />0 <br />n. <br />N <br />0 <br />2 <br />-i <br />z <br />Fee Rec: /So • od <br />Check#: SWL7 <br />co <br />z <br />o <br />m <br />n <br />Nm <br />z <br />z n <br />0 <br />c <br />N <br />o_ <br />zo <br />< <br />r <br />u u� <br />