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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 />% <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(ly) Structures <br />$350 <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: N q r1 �`Jt a G, <br />Property Owner's Mailing Address: q 4 . <br />Property Site Address: <br />Contact's Telephone Number: % 15- SSA - 1 12,14 <br />City <br />K, ►Q,i <br />State Zip <br />,S uS-93 <br />Contact's Email: r , {� o v-j <br />Legal Description of Property: <br />Section #: �i`� Town #: L�© N Range #: r�� W Town of: ry Ir-, 1 0 K <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br />Tax ID # (1-5 digit number; found on tax statement): f J (� / 3 <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: <br />(Home/Cabin; Commercial Business; Bedroom; Deck; etc) <br />Building Contractor: -�, L14- Sewer Installer: <br />AREA BELONN' THIS LINE FOR LAND SERVICES STAFF CO'.,NI:NIENTS/CONDITIONS ONLY <br />THIS PERMII6T IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />I 7q,-, -M) -A 2 <br />C�e CW -(� C I / 140 rc� �r_ <br />y Wes,, -( �r <br />Date of staff site visit: � Z1/ / Initials of site visit staff: <br />APPROVED BY LAND SERVICES OFFICIAL: DATE: 3� <br />UPON APPROVAL: APPLICANT 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 />C <br />Cr <br />a <br />i <br />N <br />0 <br />0 <br />0 <br />2 <br />o i <br />a <br />O <br />W CD <br />G 210 <br />o � <br />rA <br />C- <br />0 <br />v <br />w <br />�v <br />o <br />z <br />0 <br />o <br />o <br />CD <br />a <br />C7 <br />CD <br />con <br />oc <br />O k <br />F <br />� o <br />y \ <br />Fee Rec: <br />Check #: 7 y <br />r <br />CD <br />w <br />a <br />� <br />CD_ <br />C� <br />G7 <br />CDCLAO <br />iV <br />0 <br />3 <br />