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I <br />6 <br />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 AccessoryStructure <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 />WI State Statute 59.692(1v) Structures <br />$350 <br />Drivewa s/ & Campground Structures <br />$125 <br />Filling/Grading <br />$150 <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />Permit Extension (1Year 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:._Property <br />Owner's Owner's Mailing Address: a S S nne-s t;,,a SycAr(-- <br />State Zip <br />Property Site Address: ,z c' �i Sal c`i3 <br />Contact's Telephone Number: \ - y c�a - C50 t-4p <br />Contact's Email: Cam\ 7 . e, yA0%,1,CIO� <br />Legal Description of Property: V I g <br />Section #: 35 Town #:_ YO N Range #:�� W Town of: <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed <br />Tax ID # (1-5 digit number; found on tax statement): 64::L I <br />Proposed Use of Structure/Addition: ,C— <br />Anticipated Start Date: S �a w mLc, as 19 ome/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: 'T VS0 Sewer Installer: N iI Pi - <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />TLHIS PERMITIS SUBJECT TO ALLCONDITIONS LISTED BELOW: <br />�aT r o N e�✓� T Gt e- �a /z-e� cf i) ° W �a 1 Y114,0Rl �l Y Mh 11 jL" AeS/ <br />►fp 7� / �IA94(� <br />A,' / f <br />—� pjL� ,e-s we,,,, pyoUl;�t-zv saotj hOU5,e- r, s /�ere, <br />vl'o r 7L /- e_ cv d 7' ' Al ) n 07013 <br />Rate of staff site visit: L3 Initials of site visit staff: i <br />Ta <br />A' <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: ✓` <br />UPON APPROVAL: APPLICA T 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 8/2018 <br />�. , <br />o � <br />CD <br />CD <br />a. <br />d <br />C <br />o <br />�a <br />CD <br />Q� c <br />o N <br />c <br />d <br />o v4 <br />via <br />r7 <br />o � <br />� a <br />Q <br />z <br />z C <br />Fee Rec: <br />Check #: ,235Ub <br />E <br />r <br />mp <br />joj <br />b <br />-0 <br />o (D <br />W n00 <br />fl C <br />N <br />vi- <br />H <br />