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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 (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: 1 11 <br />Property Owner's Mailing Address: iA) e-e-�a t7ly:)it ?-�- t —rG-LIE <br />City State Zip <br />Property Site Address: . <br />Contact's Telephone Number: Cp <br />Contact's Email: <br />Legal Description of Property: L-OLL .�z 0,541 V/K, P/j 317 <br />Section #: Town #:_'t]_N Range #: / 142 W Town o£ -e5�t�J sif-�, <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): <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date:— — /— (Home Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: 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 />�- / )o- b e- U S e-*- -�v` �1 N <br />74 <br />Date of staff site visit: Initials of site visit staff:�� <br />APPROVED BY LAND SERVICES OFFICIAL: DATE: %Z <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 />ro <br />N <br />0 <br />0 <br />roCD <br />r <br />b <br />C <br />Ca. <br />d <br />yr� C <br />\ c <br />M <br />O <br />r <br />o <br />ro <br />r � <br />0 <br />0 <br />ro <br />as <br />o <br />y <br />d <br />� <br />z <br />V <br />Fee Rec: ✓U'- <br />Check #: -2fV1 <br />-H <br />