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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 />1 <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(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 />1 $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 accessory structures, such as: pergolos, landscaping, etc. <br />Property Owner's Name:'(D4 4 i el 19, Val 1 G� <br />Property Owner's Mailing Address: Oak,4XYdIS 2 <br />Ci State Zip <br />Property Site Address: 2 � 2 y 3 F ye 11 out R,Ver� %y «�� }�_ 5�0 3 O <br />Contact's Telephone Number:l z) i b% 5'9 Sri <br />Contact's Email:\,(4 vie / <br />n <br />Legal Description of Property: -5 --✓ rtj E "eL.,, sj,,0 VD w Rao �- )t.t,J <br />Section #:�_ Town Range #: I W Town of: L 1 f <br />*Attach additiona/page if neededfor lengthy description OR attache cpy`gy of the dee�j OR attach tax sent propergage. <br />{iu•o� : r<f6.Vn`S Ktv�r (—'r�CiS <br />Tax ID # (1-5 digit number; found on tax statement): V - <br />Proposed Use of Structure/Addition: 54-61"A I-4/ 5eet <br />Anticipated Start Date: // 1 AV 0-j (Nome/Cabin; Commercial Business; Bedroom, Deck; etc.) <br />Building Contractor: /vo rACOWCo Sewer Installer: AiA <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERIMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />1O1 -�Q <br />a• o s e. t ko sn �� C�Y� �-- 10, �- <br />' <br />Date of staff site visit: Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: <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 />�,' <br />y <br />00 <br />a <br />w <br />5' <br />ft <br />n <br />r <br />0 <br />r <br />0 <br />m <br />E-' <br />5 <br />t~ <br />b <br />y� Fee RecASn <br />N Check <br />d <br />a <br />z <br />v <br />y C <br />u(Ju <br />W <br />� n <br />m <br />C-71 <br />0 <br />CAD <br />Q, <br />-21 <br />