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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 />300 <br />Dwelling/Principal Structure $Addition/Alteration to Dwelling/Principal Structure <br />$20C <br />Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure <br />$20C <br />Accessory Structure (Garage, Shed, etc.) $150 Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) $200 Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse <br />$250 <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(1v) Structures <br />$350 <br />Filling/Grading $150 Boathouse <br />$500 <br />Six Month CampingUnit (One Per Year) $300 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, landscapina, etc. <br />Property Owner's Name: t- LI—ci G A 14 t <br />Property Owner's Mailing Address: 7 0 <br />Property Site Address: Sr %n �C, <br />/a <br />City <br />State Zip <br />Contact's Telephone Number: 7 /� - ,�, /, 41 (c, V <br />Contact's Email: ` <br />Legal Description of Property: <br />//11�7 <br />Section #:� Town #: 7O N Range #:W Town of.. <br />*Attach additiFl page if need3j r lengthy description QI pttach a copy of the deed Off t c to stern property page. <br />Tax ID # (1-9 digit number; found on tax statement): <br />({/ 391p Q %�l�/ /( <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: <br />Building Contractor: <br />Sewer Installer: <br />Cry <br />; Bedroom; <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />�J THIS PERMIT IS SUBJECT TO AL.LyCONDIJT, IONS LISTED _B/ELOW: <br />�� l 5 710 IM J S= / e- lrt,0 t f S 2_ 4v1 Q Ci QI OCk 9 ei� <br />�471A�e, 4- 0,0, h017 �etf 74ev <br />-SA lq�zl 1'0j� Iq Ha 14)czZ, 6 �Cwm Ma4 A <br />Ge_ w►mA4'i�t,� 4A Uj lA4^ ",le*" 1S 60C'05e.- 014. <br />,9 ►�`�i fey/%ta� t� �I irl Zo 1�7L• o� <br />Date of staff site visit: 7� Z % Initials of site visit staff: <br />OH W M - (90;4u., s ou %� rJ' �� u^r,�l`f � s p .s -0y4jA e-ii oh <br />APPROVED BY LAND SERVICES OFFICIAL: DATE:_ 5/711 <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: - <br />Pagel of 4 <br />Laserfische: - Burnett County, WI Land Use Application - Rev 1/2019 <br />a <br />0' <br />c <br />0 <br />r <br />0 <br />9' <br />0 <br />'v <br />c <br />a <br />rn <br />y <br />a <br />d <br />w <br />0 <br />o w <br />� x <br />o C7 <br />y �d <br />z <br />G <br />A <br />fl �� <br />Fee Rec: 3 <br />Check #:3'34 <br />r <br />A� <br />a <br />(co <br />ma <br />o <br />w <br />c� <br />� <br />ca <br />C <br />