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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 />411 <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(iv) 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 accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: RL ^') <br />Property Owner's Mailing Address: zPf (/ o S % 1 *1Q <br />Ciry State Zip <br />Property Site Address: '? �'� '1 G �C Q Q,� DIQYU10 fay Gt y - -`! <br />, <br />Contact's Telephone Number: ` �/S — ��•• .� l� <br />Contact's Email: 4"Q j L= b A al i 4 9" <br />Legal Description of Property: j�l' i/ t% 64F c-I J Oh d y -rAWn s 4 , P 14I `V 160 <br />Section #: ,�) LI Town #: r N Range #: �, W Town of: < Li t I " . < <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 r <br />Proposed Use of Structure/Addition: trtom <br />Anticipated Start Date: S__� Ls� j CA (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: jIC Tc $ R/71, n CkOs:f Sewer Installer: r 0, S.S t 0e-4,4o D <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />�C4vo1M �or•�� �l a 77.t/� �Cd� SQhI'7�y <br />Date of staff site visit: 7 ?, / Initials of site visit staff: <br />APPROVED BY LAND SERVICES OFFICIAL: C DATE: �T <br />UPON APPROVAL: APPL CANT 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 />� b <br />c �O <br />0 <br />0. <br />', O <br />F <br />o ._ <br />o (0 <br />CD <br />m <br />0 <br />m� <br />b <br />r � ^ <br />0 <br />z <br />0 <br />Cn <br />y <br />o O <br />�OQ <br />a <br />C7 <br />CD <br />ro <br />ao <br />Cn <br />� d <br />y C� <br />`v <br />Fee Rec: <br />Check #: ')�i(c <br />°° <br />C� <br />y <br />o <br />Do <br />wz <br />c� <br />c� <br />f It <br />