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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 />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 />$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 />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 />Permit Extension (I Year Extension - Allowed Once) <br />$100 <br />*NOTE: After -the -fact permits (permit aqui red after construction has begun) may cost up to three times the normal fee. <br />*Communication Towers & Signs require a different application form; see corresponding application, and fees. <br />*Items not listed above will be treated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: 1" ► kTt '96NC V ley <br />Property Owner's Mailing Address: 49 41 Lr44%40 64C -SW409C MW 5 S4331 <br />5 Property Site Address: 4� LA 14C 24 vA - tDAA— g4 , city 1 State D Zip <br />t �/ <br />Contact's Telephone Number: (pi z - 3 /G (D - 61 Inv <br />Contact's Email: t GT oy �C r— />4.��$S 1 WA S• <br />Legal Description of Property: L-01 4 C 5 M" V Z^ P :?( <br />Section #:M Town #: 41 N Range #: 1J W Town of- SmsS <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 statement): % I a 14 <br />Proposed Use of Structure/Addition: SC 69 N{ � 41 <br />Anticipated Start Date: Zoil (Home/Cabin; Commercial Business; Bedroom; Deck; etc) <br />Building Contractor: 5+t" MCCItS{^ 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 />10 s1�1rs 7LV � �a GV'�C— s/v-W C 74Aey <br />�►"-41 71V re,wt,et AS , lQe-e— Qf <br />Date of staff site visit: / Initials of site visit staff: <br />APPROVED BY LAND SERVICES OFFICIAL: <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: - Page I of 4 <br />Laserfische: - Burnett County, WI Land Use Application — Rev 1/2019 <br />0 <br />0 <br />�a <br />5 <br />o � <br />C7 <br />Fee Rec:_- <br />Check #: 5(� <br />r <br />A cca <br />00 <br />me <br />� <br />t� <br />cm <br />o_ <br />3 <br />co <br />JM <br />