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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 />Bunkhouse <br />$250 <br />Driveways/ & Campground Structures <br />$125 <br />WI State Statute 59.692(ly) Structures <br />$350 <br />Filling/Grading ::::]$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:_' V V hltmore !�I --�5 ��n �/ L <br />— <br />Property Owner's Mailing Address: 3 Se-06 A VW 1 1 U Mft 801? <br />_ City State Zip - <br />Property Site Address: Z 5 j� }� i YZ� j+ 1 5 I-AyQ1 4� 11Z4 badha(�/ .' (4,Z <br />Contact's Telephone Number: i>-SQvgA P CTM� bo, '715 -5 b-6_ Z-A3 5 <br />Contact's Email: b rzq C1 o 0- -1' 2 r-3 01t> w 1 Al <br />Legal Description of Property: G L� 7 <br />Section #:112) Town #-A0 * N Range #:-A!!�_W Town of. SCO <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br />l O /s- 7 <br />Tax ID # (1-5 digit number; found on tax statement): <br />Proposed Use of Structure/Addition: tiY\- J 14VzOi�yV� VV)t>V S-- <br />Anticipated Start Date:) 1 (Hom Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: ?P—jeO ©w Sewer Installer: v�%y f S A .b I N V <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />eM J^^ 17 ,s �� e / e/1, 1� � H � <br />Se,���oc�s oNci �a� a��av•� 3 �e�ow) sys�� <br />6 �.Q" lroO Lv► f 1��1� �iK V^.v cif �l Lt g C� N �1 lO u a /+G GI o u S �. <br />Date of staff site visit: Initials of site visit staff: <br />APPROVED BY LAND SERVICES OFFICIAL: QDATE: ' / <br />UPON APPROVAL: APP ICANT 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 />ITI <br />0 <br />a <br />w <br />5 <br />4 <br />4 <br />0 <br />m <br />ti <br />z <br />Fee Rec:� <br />Check #: IF 3 3F� <br />a <br />ry <br />fV <br />rV <br />O <br />cc <br />