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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 />Driveways/ & Campground Structures <br />$125 <br />WI State Statute 59.692(1v) Structures <br />$350 <br />Filling/Grading <br />$150 <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$1 00 <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 />Property Owner's Name: 147 / C I-14 FG-. Ile /c9X <br />Property Owner's Mailing Address: : W1V GANr L/rt1C�CAkr il/ $���' <br />City State Zip <br />Property Site Address: Z 7�.�,3 �/.�kt= �/g/�� <br />Contact's Telephone Number: 6 ✓-/ J—O <br />Contact's Email: X 141/ KR 0 f;" <br />Legal Description of Property: L ? % e-flt l * ' Y02-* iV /3 /0L 6 / i6 0 V, <br />Section #:34 Town #: N Range #: 14 W Town of: SC O T'T • <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): F/ (o <br />Proposed Use of Structur Additio le/ fC /� F'eJ / b <br />Anticipated Start Date: 0 (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: lf/YA/E lVomC /QFMOOE'4,n/t; Sewer Installer: /ST/AjC, <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />�'L� / �, Initials pit/• I " —" <br />Date of staff site visit: of site visit staff: <br />(—,-JE—DATE: <br />APPROVED BY LAND SERVICES OFFICIAL: !./. /' 7 ' % % • 12 <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 />v <br />5 <br />N <br />UQ <br />r <br />a. <br />o <br />m <br />�C O <br />G� <br />< \ `, <br />s <br />I <br />r � � <br />o ° � <br />6\ <br />W <br />° N 1 <br />C b <br />a <br />d <br />1� <br />� � d <br />� b <br />z <br />41 <br />Fee Rec:o�C/Q <br />Check #: 3/3 W <br />3 <br />� <br />CD <br />CA <br />3 <br />i� <br />