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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 />$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(ly) Structures <br />$350 <br />Filling/Grading <br />$150 <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />1 <br />jPermit 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 such as: pergolas, landscaping, etc. <br />ystructures, <br />Property Owner's Name: ✓t7� y u`�h z�p— �✓f� <br />!�� <br />Property Owner's Mailing Address: 7la ���us:� ,t'� /f/!� pa 'G�h1rL <br />4 // / it State Zi <br />Property Site Address:1,91 dli���«p' <br />Contact's Telephone Number: <br />Contact's Email: a{;�p'r L:' ,4d%, Gy = <br />Legal Description of Property: Q f^5, 461 t 0 <br />Section #: 2 Town #: N Range #: /� W Town of: V&zk r(!.l <br />*Attach additional page if needed for lengthy description OR attach a copyofthe deed OR attach tax system property page. <br />� <br />Tax ID # (1-5 digit number; found on tax statement): o ` <br />Proposed Use of Structure/Addition: C� y , . � `�}� � V <br />Anticipated Start Date: /Yj 4 y (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: tin 64�— 6-0115-/ Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />4 u V-,P- w► i` �- / D s , a� <br />y-'F `C ��. ►^�1e-� 1 ca v��o ✓'7 / S /'ce.-07 4- <br />�- <br />/uv%-d Use- pe,,� i`� nee�s -1 6P— ©114�6y <br />Date of staff site visit: y Z j Initials of site visit staff: <br />APPROVED BY LAND SERVICES OFFICIAL: DATE: 3 l <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 />CD <br />1%A <br />Con <br />9 <br />2 <br />H <br />x Fee Rec: <br />Check #:p�� <br />d <br />a <br />z <br />d <br />< <br />a <br />m W <br />mtD.. <br />n <br />r�s <br />� to <br />00 <br />Lo <br />0 <br />m <br />3 <br />m <br />mCD <br />i <br />rl <br />