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A", <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 <br />Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure $300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Z Accessory Structure (Garage, Shed, etc.) $150 <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) $200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Driveways/ & Campground Structures $125 <br />Bunkhouse <br />WI State Statute 59.692(1v) Structures <br />$250 <br />$350 <br />Filling/Grading $150 <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) $100 <br />Permit Extension (t Year Extension - Allowed Once) <br />$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: t�,vV1 1� : 4— 1A t1 \► Vt1 l'�' �y� �+�— ��� <br />Property Owner's Mailing Address: I Z l 1+ 3 C'an-Vr `1 L r% V t-V)N .:7 51': <br />Cityi- State Zip <br />Property Site Address: _� `3� ,� c1 n �� L, e. K e Zc.� t;W k, �4"f' G. <br />Contact's Telephone Number: 57-1 <br />Contact's Email >,� 1p� tL. 1'1 C,1, 4'e" 4 Tyo.\� Com, lye <br />Legal Description of Property: 3 C 5 f'Y\ V a Z,_ <br />Section #: . ✓ Town #: N Range #: % 5� W Town of:\ --FA <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): QL <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: i "�' (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: fa Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT 1S SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />VA►� <br />.— S,rvz_ <br />0-�� C_J\/� f (� <br />Date of staff site visit: ) / Initials of site visit staff: Y's CY3 <br />APPROVED BY LAND SERVICES OFFICIAL.-;2,DATE) S <br />UPON APPROVAL: APPLICANT <br />UST 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 1/2019 <br />N <br />c <br />s <br />0 <br />n <br />r - <br />r <br />C <br />I� <br />1091 <br />(A <br />3 <br />x <br />U <br />0 <br />R3 <br />Fee Rec: 1 ,� <br />Check #: <br />