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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 />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 />f$3Addition/Alteration <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) <br />Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/SidewalkBunkhouse <br />$250 <br />Driveways/ &Campground Structures000 <br />WI State Statute 59.692(1v) Structures <br />$350 <br />Filling/Grading <br />150 <br />I <br />jBoathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />1 <br />1 Permit Extension (1Year Extension -Allowed Once) <br />$100 <br />*NOTE: After -the -fad 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: (,(% (' I �f ti C i- S Q V\, <br />5 ) <br />Property Owner's Mailing Address: `1 fi 7 ®S �' ,1' YY ✓ �i �� ur n t� �� (V 5y5 0 $ aZ <br />PropertySite Address: U S5 Q,¢� S City State Zip <br />rV � 11 N4P0y W1 1Y0 <br />i <br />Contact's Telephone Number: <br />` <br />Contact's Email: J t, v ei'� 5 m 1M, V1k <br />Legal Description of Property: <br />`A <br />Section #: 13 Town #: l Q N Range #:_/7 W Town of: r r <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page. <br />Tax ID # (1-5 digit number; found on tax statement): <br />Proposed Use of Structure/Addition: 6,4 y', -! 1 — <br />Anticipated Start Date: J"t, ► G 1,d 6 a (Home/Cabin; Commercial Business,: Bedroom: Deck; etc) <br />Building Contractor: �e Sewer Installer: &YJli, 0,5 <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />05, u <br />(its T U Ott G r t4- L ^ 1 `f "+ /a jt oVla % 2,x� 4 k1 S 1 r� k*\_ q 7.0 t4,4 A e4A <br />Date of staff site visit: Initials of site visit staff: <br />APPROVED BY LAND SERVICES OFFICIAL: DATE: 7 �0// <br />UPON APPROVAL: APPLICANT 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 />0 00 <br />GQ <br />0 <br />y <br />o' <br />o � <br />0 <br />N <br />z �p <br />s Fee Rec: <br />y Check #: /5 h <br />cn <br />r, <br />a <br />�m <br />r <br />y 0CD <br />Do <br />Ln <br />0 <br />C <br />