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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(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: 24 %A� d ey\ 19 cif vt, ( 4, `y ( <br />Property Owner's Mailing Address: a`+� 7� 3 oo h Sc� ti 4 ��� D t 10,jrV✓.T 5tf,5 30 <br />City State Zip <br />Property Site Address: S 0.w Q <br />Contact's Telephone Number: -715- — 55 I j <br />Contact's Email: r -05e*► jOoZdQ w�cr .LOrv% <br />Legal Description of Property: <br />Section #: 13 Town #: LID N Range #: 16 W Town of: OQk 1-qhd <br />*Attach additional page if needed for lengthy description OR attach <br />a copy of the deed OR attach tax system property page.* <br />Tax ID # (1-5 digit number; found on tax statement): 1 3) a. 4 <br />Proposed Use of Structure/Addition: S �,eS — s4 -,-,Se. <br />Anticipated Start Date: L4 — ( " 20 (� r fj (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: &4e YeL� Vy,'9,hg5 Sewer Installer: A <br />�r <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 site visit staff: <br />APPROVED BY LAND SERVICES OFFICIAL,DATE: / S <br />UPON APPROVAL: APPLICA MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: - <br />Page 1 of 4 <br />Laserfische: - Burnett County, WI Land Use Application — Rev 1/2019 <br />a <br />r <br />o a � <br />O <br />�CD <br />CD <br />o <br />p <br />b <br />r <br />o z <br />o rt <br />^n V <br />b <br />o y <br />C <br />a <br />iD <br />o ao <br />a <br />0 <br />W � � <br />d <br />O <br />z <br />a <br />t7� <br />Fee ReJ/Jo <br />y Check #: /06 <br />5 <br />m <br />e <br />2-1 <br />N, <br />ER <br />E <br />