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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 />I <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 />1 <br />IWI State Statute 59.692(1v) Structures <br />$350 <br />Filling/Grading <br />$150 <br />1$100 <br />1 <br />lBoathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />1 <br />113ermit Extension (1 Year Extension - Allowed Once) <br />$100 <br />*NOTE: After -the -fact permits (permit aquired after construction has begun) may cost up to three times the normal fee. <br />*Communication Towers & Signs require a different application form; see corresponding application, and fees. <br />*Items not listed above will be treated as accessory structures, such as: pergolas, landscaping, etc. <br />r- <br />Property Owner's Name: !X� <br />pp <br />Property Owner's Mailing Address:%04,3 `lo `'�(�I /�/ /jIf?rl_c �/QaIle, /► ^1 S573 <br />City State Zip <br />Property Site Address: �40 �1 Kc ;pjt Al� - V�t(�,5 ,,,I I <br />Contact's Telephone Number: %-3'3lPo-$,2 <br />Contact's Email: ) r-,e hr jkv14K <br />Legal Description of Property: <br />tj <br />Section #: c % Town #: 35 9 N Range #: /� ,� W Town of: <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): —:�.z 9y 7 <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: (Horne/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 />p u <br />y <br />Date of staff site visit: Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: TE: �6 / <br />UPON APPROVAL: APPLICA T 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 />v <br />s <br />a <br />Fee Rec: 60 _— <br />Check #: 1 (A ?ro <br />a <br />(D� <br />� w <br />J <br />CD 00 <br />-0 <br />Boa r� <br />o <br />w� <br />� <br />cn <br />ca <br />