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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 />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 />IWI 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 />Permit 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: z" 1K /1�G re- L L <br />s1/893 <br />Property Owner's Mailing Address: 4000 pig ke Be 7-/ Ate v- A-1/sc � <br />Ci y Stafe Zip <br />Property Site Address: tnel Ay a 1. Ale 6s l, <br />Contact's Telephone Number: lu %t l eLL-- LGLL (o �2-%/S•-O� /�,? <br />Contact's Email: /f o/',e [ C ^' C <br />Legal Description of Property: ; PC, / `y — <br />Section #:�_ Town #:__7 _q _N Range #:_W Town of: <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): /,2 p 3 / <br />Proposed Use of Structure/Addition: La 6,,tit -- Ado04s'ert e.F Ste! role- j!Z.P,,-1 i- � <br />Anticipated Start Date: S'�� C 8 ►Ar .2 O 1 T (Hom,4Zbin; Commercial Business; Bedroom; Deck; etc.) <br />Llves !n <br />Building Contractor: cAad No fe L Sewer Installer: <br />-tt -7i5--S'2-v •►779r8 <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COWNIENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Gros e r f 7i e. �b17 <br />f '106 y e4 t o o -C//cfy,c <br />sc,/© P, 6/3�19-, <br />i Ae, 10 0t&- a vr-A © f- i%(L <br />Merl �7C' <br />Date of staff site visit: Initials of site visit staff: ! // <br />APPROVED BY LAND SERVICES OFFICIAL: ATE: <br />27 <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: - <br />Laserfische: - <br />Page 1 of 4 <br />Burnett County, WI Land Use Application - Rev 1/2019 <br />c <br />�o <br />r <br />0 <br />N <br />O <br />w <br />Fee Rec: <br />Check #: in n <br />