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r <br />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 />$300rAddition/Alte <br />tion/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure <br />$300tion/Alteration <br />to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) <br />$150ration <br />to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) <br />$200ion/Alteration <br />to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />house <br />$250 <br />Statute 59.692(1v) Structures <br />$350 <br />Driveways/ & Campground Structures <br />$125ate <br />Filling/Grading <br />$150house <br />$500 <br />1$100 <br />Six Month Camping Unit (One Per Year) <br />$100it <br />Extension (1 Year Extension - Allowed Once) <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:.n1 Z <br />Property Owner's Mailing Address: OJA L G lf-`l T Aff 17 X1aUV1,4 0j 53-1I 9 <br />City State Zip <br />Property Site Address: 3 /o .3 � Bu C.�/, D t. �ca�bV n4 (AJ �" r7 3 Ci <br />Contact's Telephone Number: 6 / .)- —2G 2 lit 6 5-7 <br />Contact's Email: t1 N Z-g/ 415 A, L O wt <br />1G( S / qHV z SNP- <br />Legal Description of Property: �/ q <br />Section #:13 Town #: N Range #: f S W Town of: 'Suj t 5 5 <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): t9 1 3 3 & <br />Proposed Use of Structure/Addition: G i , l e,4, / P() I,( 13C,r V\ <br />Anticipated Start Date: MA Y / 0 / (Han lCabin; Commercial Business; Bedroom; Deck: etc.) <br />Building Contractor: Sewer Installer: PZA <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />PERMIT IS SUBJECT TO CONDIT%ION%S LISTED BELOW: <br />?THIS /ALL <br />71- all <br />C 4 N4�e- • / L <br />C� <br />Date of staff site visit: z",� / Initials of site visit staff: 71 <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 />t7 <br />w <br />m <br />1 <br />0 <br />n <br />C <br />0 <br />9 <br />n. <br />^o <br />Cn <br />I <br />::�e49l <br />Fee Rec: <br />Check #: <br />