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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 />Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) <br />f$200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/SidewalkBunkhouse <br />Driveways/ & Campground Structures <br />$250 <br />WI State Statute 59.692(iv) Structures <br />$350 <br />Filling/Grading <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />Permit Extension (1 Year Extension - Allowed Once) <br />$100 <br />'NOTE: After -the -fact permits (permit aquired after construction has begun) may cost up to three times the normal fee. <br />*Communication Towers & Signs require a different application form; see corresponding application, and fees. <br />*Items not listed above will be treated as accessory structures, such as: pergolas, landscaping, etc. <br />?roperty Owner's Name: -/7 0197#-,5 C ja. rl ► C e- to su= <br />'roperty Owner's Mailing Address: 4, Dcn 6 n' ,V:? <br />City State Zip <br />roperty Site Address: �w y 45, kyl C A CL- oy'� <br />:ontact's Telephone Number: <br />:ontact's EmailA o m 6 %/,er- t R C�yc , ��a Yr) <br />n i r A <br />T o a-1 Description f Uropee .,• �?rj ^ NW ,—X . 141 .%a' 5 > 1--ax._ /-7" ."> <br />accuvu rr._i uwii tr:—ILL N Rdiloc tr. t .J yr i uwuvi. / <br />*Attach additionalpage if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. * <br />Tax ID # (1-5 digit number; found on tax statement): 2I % 3 7 <br />Proposed Use of Structure/Addition-U r)��1'�- <br />Anticipated Start Date: /r jO i t ftmelCabhu Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: 2Qr-r Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />�-��r vr� S1aA- XQ 77 a Pew A V/4 llgX 4 o � <br />$ I yJ m ►^ �' f Ll 4 �'1 �_ 1k) t CiA 15 cl V / 4/4T/4 <br />Co ha4 �d s1s .S 74 74!40_ /h <br />Date of staff % z <br />f site visit: 3 Z % % Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES <br />TE: <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 />9z <br />a <br />Cr <br />o' <br />0 <br />-4 <br />b r <br />� b <br />y ate' <br />A � 1 <br />w <br />iD <br />F <br />0 <br />C <br />0 <br />r <br />0 <br />z <br />0 <br />O y , <br />c <br />I� <br />o w <br />k <br />d <br />X v <br />Fee Rec:� <br />Check #: <br />r <br />w <br />n <br />� <br />W� <br />n <br />;2 <br />C <br />C.91 <br />C= <br />5� <br />O <br />� <br />co <br />Y_Y <br />