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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 />$300 <br />Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />ommercial/Industrial Structure <br />$300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />ccessory Structure (Garage, Shed, etc.) <br />$150 <br />I <br />Addition/Alteration to Accessory Structure <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 />IWI State Statute 59.692(1v) Structures <br />$350 <br />Driveways/ & Campground Structures <br />$125 <br />Filling/Grading <br />$150 <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />113ermit 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, landscaping, etc. <br />Property Owner's Name:/q.�L� 'Vi-Gy� �`C✓ �(�!—'i e <br />Property Owner's Mailing Address: �l%lp O.� �i �Q 0R%VBI�R� cry <br />_ City to Zip <br />V/' <br />Property Site Address: <br />// <br />Contact's Telephone Number: lf�% -;70 - ®�%%ZI(�''oc%� <br />Contact's Email: AA /t %9]-1G 7-R%�'�j�/���%`M" Aljr, - <br />n% <br />Legal Description of Property: zjmr �,6� 9;9� <br />Section #:,5/1 Town #:l'Yl N Range #:,Q l� W Town of- zn�w,,,Z66 <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br />Al ceA 8� <br />6 Tax ID # (1-5 digit number; found on tax statement `"AW <br />C y! 4rr4el <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: AS 040Il A07 OetAb, ome/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />//�oxv <br />Building Contractor: �����U� 8wer� <br />sa11e0 <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF CO MEN XONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />A � Cw e) aGG�SSDt�y S(J741AC -e (PAl % A E—J�9Ncd <br />I,e_ "� <br />rme— 'm qh 00/ ��i , h � es^r.�r7 <br />7cf 7-0 e— <br />Date of staff site visit: Initials of site visit staff: <br />APPROVED BY LAND SERVICES OFFICIAL: — DATE: <br />UPON APPROVAL: APP 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 />0_ <br />Fee Rec: <br />Check #: , 1165 <br />8 <br />r <br />Q <br />�- <br />CDW <br /><3 <br />00 <br />o <br />CD ' <br />N <br />C <br />