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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 />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 />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 EK cicq— <br />Property Owner's Mailing Address: R o- 3CK OvCgccA- i,� �c(o 3o <br />City State Zip <br />f <br />Property Site Address: :9u a-? (p ).( i . ko - b r cj,un <br />G�eu <br />Contact's Telephone Number: �� ✓ '" �QZr d4gl <br />Contact's Email: htM� i)cs� <br />c <br />Legal Description of Property: Ld13f tyty, 3qiIC A) /0 <br />Section #:�?LA Town #: �N Range #:J(,,p _W Town of: 151r,(Ss <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): o23 i O �k, <br />Proposed Use of Structure/Addition: FYIIN- 4e L44C 'bl L ntn # <br />Anticipated Start Date:-5/1 406' (Home/Cabin; Commercial B siness; Bedroom: Deck; etc.) <br />Building Contractor: �f bvtsr'(— 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 />Date of staff site visit: s Z J Initials of site visit staff: <br />APPROVED BY LAND SERVICES OFFICIAL: DATE: : 3 l <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: - Page I of 4 <br />Laserfische: - Burnett County, WI Land Use Application — Rev 1/2019 <br />0 <br />0 <br />A <br />.� Fee Rec:_���. <br />Check #: ��CO <br />10 <br />0 <br />m <br />d <br />z <br />2 <br />9 <br />^d <br />