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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 />jWl State Statute 59.692(ly) 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 pergolas, landscaping, etc. <br />jas�: <br />Property Owner's Name: R(a ^� �1 C�.- C'T'l y— <br />Property Owner's Mailing Address: eer g3AE, G W I � Y� <br />City St to Zip <br />Property Site Address: SC-rn4 CQS , 4386"-ess <br />Contact's Telephone Number: e �i CA :7 0 9 <br />Contact's Email: WACA-)k-Irp 11(p(2 c4ft-C-, Cat In <br />p _ , i l r 7 <br />Legal Description Property: L�� (Y1 Z,2 ?2— c •a ' —I (Q I) <br />of V <br />Section Town #:�' �N Range #: W Town of:�J]��'S 5 <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): Z) 3 ) 1 <br />Proposed Use of Structure/Addition: Skom Ccu- :Tr".cA , J i(Ael 6,i SIC1E <br />Anticipated Start Date: (Home/Cabin: Conmzercial 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 />/vef T, v1 S r" N w�ti� Ul4!0I'��i'd ✓L . <br />c v ` q ► r1. w will Le-- �/f t�i� 01A Cf <br />Date of staff site visit: & Initials of site visit staff: / r <br />APPROVED BY LAND SERVICES OFFICIAL: DATE: cell / I <br />UPON APPROVAL: APP ICANT 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 />N <br />0 <br />5' <br />u� <br />x <br />d <br />a <br />,17 <br />d <br />w <br />U <br />o <br />CD <br />0 <br />a <br />w <br />ro <br />z <br />0 <br />o <br />e <br />CD <br />b <br />oa <br />o � <br />y x <br />d C7 <br />H <br />N <br />W <br />z <br />Fee Rec: J�0 <br />Check #: <br />