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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 />WI State Statute 59.692(1v) Structures <br />$350 <br />Drivewa s/ & Campground Structures <br />$125 <br />Filling/Grading <br />$150 <br />Boathouse <br />$500 <br />1$100 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />Permit Extension (1 Year Extension - Allowed Once) <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: _ )tom) <br />f (`, zz <br />Property Owner's Mailing Address:: / l Lf I �C' i. yv ' s 6 ,J <br />( i/ , I City St e Zip <br />Property Site Address:,-?7C v LAK E ! W�i ,£y_1 A I S Y) 1O 3 <br />Contact's Telephone Number: <br />Contact's Email: ! j ir1'lci-i �'i �IJ� i'Y15r) • CCU' "n <br />Legal Description of Property: e6Yv. * 4-N(o <br />Section #: Q B Town #: 1FO N Range #: ( S W Town of: Nd", <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): 33 6 ff I <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: 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 />le- V/o�Q7l7o�'15 ©�VaelI 11S <br />t�s Cell <br />Date of staff site visit: Initials of site visit staff: ' <br />APPROVED BY LAND SERVICES OFFICIAL: ATE: 3 Z9 % <br />UPON APPROVAL: APP ICANT 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 />I� <br />