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LAND USE PERNUT 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 AccessoryStructure <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 />Driveways/ & Campground Structures <br />$125 <br />1 <br />jWl State Statute 59.692(ly) Structures <br />$350 <br />Fillin Grading <br />$150 <br />f <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />1 <br />1permit 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: LE <br />Property Owner's Mailing Address: i`7 v �- %�L ti Al 0 VA n 4K 2> I it <br />��+ City State Zip <br />Property Site Address: &✓`7 �% �C h60 ry,� t � � (/t i� hS � F r . Ir(./���t/ %q 3 <br />Contact's Telephone Number: (!J 1 �-// ` 5 9 173 �3 1 <br />Contact's Email: 1 LQ e l° P 6 f rl k 1 6 OPT I <br />►' <br />Legal Description of Property: <br />Section #: _ Town #: Li r' N Range #: W W Town of: VNI IA 11 ij) <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): j �J ` 19 <br />Proposed Use of Structure/Addition: 0i .\ t31 Y3 — ADO A \00 <br />Anticipated Start Date: /n IQ - �( (C� (Home/Cabin; Commercial Business; Bedroom; Deck, etc.) <br />Building Contractor: ­N� A41t7 0.L+i1, 4 (41-1 It) Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERNUT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Date of staff site visit: Initials of site v' ' taff: / <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 />g <br />ov <br />Cn <br />r <br />;o <br />a <br />0 <br />O <br />1 <br />�l <br />m <br />M <br />z <br />o J <br />r. <br />l <br />c <br />n. <br />C7 <br />m <br />I <br />yo <br />d d <br />C� <br />-V <br />Fee Re : c� <br />Check #: <br />r <br />w <br />a <br />0 C <br />�- <br />A cNJ <br />C= <br />r� <br />