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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 />x <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 />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 _f OMOI-e, I/ fbe,4- LLIL <br />Property Owner's Mailing Address: 38e-o6NhAvw U Mfrox, <br />_ City State Z� <br />Property Site Address: Z 165b6' B i YZ(. + 1 S jt4*'D �n l ym 1 b6td.bItAl -` tur �I33& <br />Contact's Telephone Number: iN1z1gA l? c Tl; zSUi1 Z f 5-5k76-Z-A3 5 <br />Contact's Email: b � r pe'r e 1" s D iR�' 1 t31 � � W1 ✓� i � . <br />Legal Description of Property: G L- 7 <br />Section #: _Town #'q0 * N Range #:--A4 _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 />Tax ID # (1-5 digit number; found on tax statement): <br />Proposed Use of Structure/Addition: 4" �i� / t4�ItiA�t R\1WW%V SE <br />Anticipated Start Date: I O-N) 1 d f` (xom Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: ?PTe0VV%� jCt �D\A ST Sewer Installer: 'A©(0fK%&j16A1b I !�? (MV <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />7�,�5 P �„�, f ,i ,��e a e/%?� H �u•�ouse <br />SCop—flpbDs oNd �aof a '�/v� 3 �e owe SysT � <br />Vde,alp-oow►S �C.7�j�ecrt 4�Wcif/lGl9 C�vl�" lOuaKZilDuS�. <br />23 l9 <br />Date of staff site visit: Initials of site visit staff: <br />�r <br />j <br />APPROVED BY LAND SERVICES OFFICIAL: DATE: <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 />