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LAND USE PERMIT APPLICATION — Burnett Countv, 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 />mercial/Industrial Structure <br />$300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />A <br />ssory Structure (Garage, Shed, etc.) <br />$150 <br />Addition/Alteration to Accessory Structure <br />$150 <br />ccessory 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(ly) Structures <br />$350 <br />Driveways/ & Campground Structures <br />$125 <br />Filling/Grading <br />$150 <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 <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 structures, such as: pergolas, landscaping, etc. <br />jacccce�ssory <br />Property Owner's Name: s I G`\�,,'G'' IfN �T�- <br />,�� <br />Property Owner's Mailing Address: ` LI —7 War" I t15 I N E I—J E -SvW 1 54 8 a�3� <br />C7 /� �,� }�City State Zip <br />Property Site Address: b V Pp 1►`rbUYU W 5Ff <br />Contact's Telephone Number: <br />Contact's Email: .5:106 J I �JW 01 I ° CfP fM <br />Legal Description of Property: W-f 3,� 1, a3 F N 219S <br />Section #: 33 Town #: 14' N Range #: 0 W Town of S1-? Is -S <br />*Attach additional page if needed for lengthy description ORattta^cch a copy of the deed OR attach tax system property page. <br />Tax ID # (1-5 digit number; found on tax statement):3 0� <br />Proposed Use of Structure/Addition: De=►n0f ieJ G�e <br />—M <br />Anticipated Start Date: 9 _30r (Home/Cahin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: SELF Sewer Installer: 0.1 A - <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />/� yletl Q Cc e s sc91 'y <br />Date of staff site visit: Initials of site visit staff: <br />APPROVED BY LAND SERVICES OFFICIAL: DATE:' <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: - Pagel of 4 <br />Laserfische: - Burnett County, WI Land Use Application — Rev 1/2019 <br />Cr <br />Ell <br />0 <br />ro <br />as <br />x <br />� d <br />r- r <br />z G� <br />Fee Rec: <br />Check #: <br />w <br />Q <br />in <br />0 <br />,on <br />_ <br />N <br />0 <br />