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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 />x <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 />Driveways/ & Campground Structures <br />$125 <br />Bunkhouse <br />$250 <br />WI State Statute 59.692(1v) Structures <br />$350 <br />Filling/Grading <br />$150 <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />1 <br />Permit Extension (1 Year Extension - Al lowed 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: /41 I C Q, e— A se k ie— <br />Property Owner's Mailing Address: Co� M r X�G")A/e L. o & <br />-{� City State Zip <br />Property Site Address: y�0 S e / / fxl yol tI 1-R a 111 w c- y %i N.�V WS SY,3 3 0 <br />�l � <br />Contact's Telephone Number: (� <br />Contact's Email: / W ACU IS J �� CAI Q-5 �' ��� <br />Legal Description of Property: d f 15"Y f 1 r 5elSKN1� a /- ! W a <br />W Town of: .1 A C If SD/V <br />Section #:_ Town #: N Range #:/,f T <br />*Attach additionalpage if needed for lengthy description OR attach a copy of thedeed OR attach tax system property page. <br />Tax ID # (1-5 digit number; found on tax statement): 3 f <br />Proposed Use of Structure/Addition: C A � t k <br />Anticipated Start Date: .Ll (Home/Cabin: Commercial Business:Bedroom, Deck; etq) <br />Building Contractor: No )Q $ C �� C-,C> Jr A-' Sewer Installer: M. ' (`�����Ns d nn,4`J <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDIT/IONNSS /LISTED BELOW: <br />yy <br />Date of staff site visit: 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, WI Land Use Application — Rev 1/2019 <br />a <br />o =; <br />❑ C7 <br />z 0 \f <br />OC1 <br />I� <br />Fee Re : <br />Check #: I Q <br />M1 <br />MH <br />