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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 <br />$300 <br />Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure <br />$300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) <br />$150 <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) <br />$200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Bunkhouse <br />$250 <br />Driveways/ & Campground Structures <br />$125 <br />IWI State Statute 59.692(1v) Structures <br />$350 <br />Filling/Grading <br />$150 <br />lBoathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />1 <br />jPermit Extension (1 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:j�1 <br />Property Owner's Mailing Address: WACILI J Iv(" \oluue W S4- J) <br />City State Zi <br />Property Site Address: � („ La, k2.— Zic 1.�Q Ct Lan h n .i (,s.i ( S•436 <br />Contact's Telephone Number: C'j 10 8 <br />Contact's Email: J/' O e, 6(11 l'1 ��� , l [ CA h )Q l/7 <br />Legal Description of Property: PC L C.1 /, �,o,; L C + <br />Section #: 2 Town #:_yfl N N Range #: 12 15 W Town of. Svi :5 S <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br />Tax ID # (1-5 digit number; found on tax statement):� <br />Proposed Use of Structure/Addition: Hum •t4"e: ,'� <br />Anticipated Start Date: L��/GJ (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: se �.' 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 />S7U6714� 15 noH- Gol^�or�..,� fv � YDC4 <br />mil zs�o l�,�s� ,�►/ �t4l <br />s�a�, <br />/ y �C, s � t.,A P �J GPP r5 7� <br />�►S <br />is Qflol.�P�� l� <br />-Cu7 U ►^2 'J'ec7�s �v1,9Gt� r e>�w� <br />cam, So Q Al P <br />e Zs /cam / <br />ct VaVI aYlGe�i <br />Date of staff site visit: 3 Z,! Initials of site visit staff: <br />BY LAND SERVICES OFFICIAL: —DATE: Z9 f <br />APPROVED <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 1/2019 <br />rr <br />b <br />o as <br />a` <br />cro <br />C7 <br />o <br />F <br />o C <br />Fee Rec:-2/>0 <br />y Check <br />