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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 />Driveways/ & Campground Structures <br />$125 <br />Bunkhouse <br />$250 <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 />lPermet 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: L-lq�ul� 2 ILo(y/L` L <br />Property Owner's Mailing Address: w I /' Jn <br />i �f � v /t/ �� N�� 1��IuNToo M vu 5 1 ( <br />Property Site Address: <br />City State Zip <br />C Q (p l C (�?55 7-owty R d <br />Contact's Telephone Number: �c' S/ - (p J rt l cY Q 9' <br />Contact's Email: I K M 0 e t)e (92) YW 5 �j C(�) 141 <br />Legal Description of Property: Lc-,- C � tj -#-3� D / u l 7 P 1 q 1-f & D <br />Section #: �!; Town #:3 S N Range #: ( ? W Town of. uacc 0 � I C e I� <br />*Attach additionalpage if neededfor 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): -� q & <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: — _ 1 .) (Home/Cabin; Commercial Business; Bedroom; Deck; etc <br />Building Contractor: J - L 0 t{ I L Ce,fl`�S Sewer Installer: V,, / / l <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />/ <br />Date of staff site visit: 3 &i lq I Initials of site visit staff: <br />APPROVED BY LAND SERVICES OFFICIAL: ATE: 3 Z9 <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 />'T <br />0 <br />0 <br />aro <br />a, <br />z <br />x <br />E <br />o � <br />� d <br />-, Fee Rec: 4"no <br />x <br />Check #: <br />m <br />