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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 />$3001 <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 />$2 00 <br />Addition/Alteration to Bunkhouse <br />$150 <br />f <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Driveways/ & Campground Structures <br />$125 <br />Bunkhouse <br />$250 <br />WI State Statute 59.692(ly) Structures <br />$350 <br />Filling/Grading <br />$150 <br />Boathouse <br />$500 <br />1$100 <br />Six Month Camping Unit (One Per Year) <br />$100 1 <br />Permit Extension (1 Year Extension - Allowed Once) <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: /9144y 1CoDe�1 <br />Property Owner's Mailing Address: 60 Sl jP1 Ae- t�f.HV AQ-1 Ji-)Chs74P4 " <br />� A d P, o/ w � State Zip <br />PropertySite Address: � �. Gt1 <br />���� "kit <br />Contact's Telephone Number: <br />Contact's Email: <br />'/ <br />Legal Description of Property: Zo2"- � G 5Ajy t' T 67 <br />Section #: 2,& Town #:_3'1_N Range #:1_W Townof- c-evte►A <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 sta ement): 11 q S <br />Proposed Use of Structure/Addition: e <br />Anticipated Start Date: (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: Sewer Installer: <br />♦ TT ♦ TTT 11TT1 TTTT['T <br />yc.ti nr.i,yw 1n13 Uli'N E rvn LAtVL ZNERy1ChS STAFF CONIMEN S/C;ONDITIONS ONLY <br />THIS PERM-ILT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />p <br />Date of staff site visit: ✓ O / Initials of site visit staff: <br />APPROVED BY LAND SERVICES OFFICIAL: DATE: -080/9 <br />UPON APPROVAL: AP 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 />� I I <br />z Fee Rec:-2ob/w <br />Check #: <br />r <br />w <br />C <br />a <br />m <br />ME <br />