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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 />Addition/Alteration to Dwelling/Princi Structure <br />$200 <br />Commercial/Industrial Structure <br />Addition/Alteration to Commerci Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) <br />Addition/Alteration to Accessory Structure <br />$150Accessory <br />Structure (Commercial/Industrial) <br />d$3 <br />Addition/Alteration to Bunkhouse <br />$150Deck/Stairs/Patio/Retaining <br />Wall/SidewalkBunkhouse <br />$250Driveways/& <br />Wl State Statute 59.692(Iv) Structures <br />$350 <br />Campground Structures <br />Filling/Grading <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <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 then~ 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: pergolos, landscaping, etc. <br />Property Owner's Name: �--),t,) �A��,��� <br />Property Owner's Mailing Address: c 1 l _ A—\j <br />I - City State Zip <br />Property Site Address: [ C .3 N 1 N ZT) P'0 6t(F :) <br />Contact's TelepboneNumber: 9x5Z- &2rD --NS) <br />Contact's Emai1:cJ�j \�@f �� C'�t�Civ�Y�x; C� A , C_ I \ <br />Legal Description of Property: Ls \ (� <br />Section #: `1 Town #:N Range #:__L4�__W Town of <br />*Attach additionalpage if needed, for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br />Tax ID # (1-5 digit number; found on tax statement): i-),t1 3 <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: (Home/Cabin; t atr mercial Businmr , Bedroom; Deck; etc) <br />Building Contractor: 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 />_. ti0 add/� �� C-Q ft',jy pe,01Ml`f-5(s�'x k-40A71-A) 1,0/// <br />l'5 Sue t l �•t 7�i t a �! / S a G� / h cc� r.�+ ii a h c,�� , �j I S <br />04:5>1q m� y. F117UP9- ���..,t �,��i tW-_fu,;'F_ <br />u l v�e,n-t S_1 14, Le- p4e-fi-. <br />Date of staff site visit: U / Initials of site visit staff: <br />APPROVED BY LAND SERVICES OFFICIAL: �DATE: % <br />UPON APPROVAL: APPL CANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: - Page 1 of 4 <br />Laserfische: - Burnett County, WTl gnd Use Application — Rev 1/2019 <br />Fee Rec:�-CX� <br />`Check <br />Irm <br />