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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 />1 <br />lAddition/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 />1 <br />jPermit 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: —Tot U <br />Property Owner's Mailing Address: SO G Yc fjJ EIS( <br />2 Y05- ^� j CityjLj State Zip <br />Property Site Address: l� J � �i�^ 4 RD �v� lAe— <br />Contact's Telephone Number: l� (2 �6 � 2- OA / <br />Contact's Email: -To SLJNrw,,� M SV (- CC) M <br />Legal Description of Property: <br />Section #: O Z Town #: N Range #: /W Town of: <br />*Attach additional page if needed for lengthy description OR attach a cool) ofthe deed OR attach tax system property page. <br />Tax ID # (1-5 digit number; found on tax statement): <br />Proposed Use of Structure/Addition: i � - J6,fAV erj <br />Anticipated Start Date: 14 (Home/Cabin: Commercial Business; Bedroom; Deck: etc) <br />Building Contractor: 01 IJ 44'Clt y SMJ> Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS <br />IS SUBJECT TO ALL CONDITIIONS LISTED BELOW: <br />--� /pr'� 54ed 011% he. rew►av'edarle,#- j4e. <br />s AC. / Is C..O w► p/Cjt... <br />Date of staff site visit: 6 ///// Initials of site visit staff: / r <br />APPROVED BY LAND SERVICES OFFICIAL: DATE: <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 />r <br />z' �d <br />o' <br />o CD �O <br />a <br />a C7 <br />m <br />^� O. <br />0 <br />m <br />m <br />-o <br />r <br />o <br />o <br />0 <br />0 <br />oa <br />Cn <br />o N <br />c <br />a. <br />d <br />CD <br />N b <br />C7 <br />o m <br />F x <br />a C7 <br />W <br />x Fee Rec 1500 <br />Check #: <br />0 <br />m <br />m � - <br />m am C= <br />3 <br />CAL <br />n b <br />3 cm <br />O <br />7�'==�� <br />niCD <br />C� <br />a+ <br />ra <br />