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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 />Driveways/ & Campground Structures <br />$125 <br />Bunkhouse <br />$250 <br />WI State Statute 59.692(1v) Structures <br />$350 <br />Filling/Grading <br />$156 <br />Boathouse <br />$500 <br />Six Month Camping Unit (one Per Year) <br />$100 1 <br />Permit Extension (1Year 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: Je-(-(-y / G fQm C <br />Property Owner's Mailing Address: Z b 3 1B 1 Co Z Ck F: E 2 A &;-i e wT 518<j o <br />Property Site Address: 514 M C R S 14IR DV C City State Zip <br />Contact's Telephone Number: $@I-1-% iPBT 0011l''. 1 `J -5 to b ZA <br />Contact's Email: b cel (A • P C I-e- ( -s & &, W i Q G m A i % ® LC) ► �) <br />Legal Description of Property: 'Di -befit 7,)(Q(. -4---JC)q b7 j <br />Section #:_ t 4 _ Town #:_ 39 N Range #:_, 14 - W Town of: W d_ ;i M A ks H t iQitl. <br />*Attach additional page if needed for lengthy description OR attach acopy of the deed OR attach tax system property page. <br />Tax ID # (1-5 digit number; found on tax statement): 2 7 ('76 <br />Proposed Use of Structure/Addition: E <br />Anticipated Start Date: /Y1LD Iq (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: Sewer Installer: fl a � w S s Ax b jam <br />—T <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />! ! V <br />Date of staff site visit: ��� � �% i' Initials of site visit staff: <br />APPROVED BY LAND SERVICES OFFICIAL: - <� "�,,A->GM DATE: y Z <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 />