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II <br />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(1v) Structures $350 <br />Filling/Grading $150 Boathouse $500 <br />Six Month Camping Unit (One Per Year) $100 Permit Extension (1 Year Extension - Allowed Once) $100 <br />*NOTE: After -the -fact permits (permit aquired after construction has begun) may cost up to three times the normal fee. <br />*Communication Towers & Signs require a different application form; see corresponding application, and fees. <br />*Items not listed above will be treated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name:4rW z: -Ix <br />Property Owner's Mailing Address: 3 lje&�, L, --f -1 /q <br />3 <br />City State Zip <br />Property Site Address: S� C- <br />Contact's <br />l <br />Contact's Telephone Number: 3 — �f 5 / � d, <br />Contact's Email: �('`.(��P�`I�' r G inac , Ir <br />Legal Description of Property* <br />$ <br />Section #:_ Town #: Y 0 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. <br />Tax ID # (1-5 digit number; found on tax statement): 1779 <br />Proposed Use of Structure/Addition: S hC.161- <br />Anticipated Start Date: ",,VmOC{�¢1; Commercial Business; Bedroom; Deck; etc.) <br />-715 <br />Building Contractor: iEi �/ nlx�s Sewer Installer: Af�� <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />�1 THIS PERMIT IS SUBJECT TOALL <br />/C`O /ND/ITIONS LISTED BELOW: <br />Q <br />%o vF ,vCoN r�►'1 N9 c5'/� till % o ,17 e �tTac�r eQ o 6 i sA ivy Ga. ra.g e- , <br />I�`lowto( o -,o5is1iiv9 9&t-o.3e. .2s;Y, /1&$jee,. zl5d, <br />Date of staff site visit: /a Initialsof s' t staff: , /y <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 />to <br />CIO <br />X� <br />O <br />E <br />Fee Rec: <br />Check -;P21 <br />16 <br />