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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 />DeckJStairs/ Patio/Retaining Wall/Sidewalk <br />Bunkhouse <br />$250 <br />J� <br />Driveways/ & Campground Structures <br />$125 <br />WI State Statute 59.692(ly) Structures <br />$350 <br />Filling/Grading <br />$150 <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />Isloo <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 wilibe treated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: %b ► vx E L en tG2 4- BF -TN )4ER.R l u< <br />Property Owner's Mailing Address; /3o©o 6R. OOD 7-ML 1h)AW67-6NKAjnh1SS�f( <br />City State Zip <br />Property Site Address: 30 33 COLA N TY Rof4 D <br />Contact's Telephone Number: 91 $Z - Z5'O • 1 130 <br />Contact's Email:__"f a 1yyxer Z0,qO"M grKek; /, COwN <br />Legal Description of Property: DEEP Ar-ITAC,1 C-D <br />Section #: 19 Town #:_ZJO_N Range #: 1 LI W Town of: 5Gp7r <br />*Attach additional page if needed for lengthy description OR attach a cop of the deed OR attach tax system properly page.* <br />Tax ID # (1-5 digit number; found on tax statement): / 9 Z 73 <br />Proposed Use of Structure/Addition: V 8C-14 <br />Anticipated Start Date: / % (Nome/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: ' 11IOMAS CeIWV AC. 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 />. <br />N t l �J/T G1 ��t/ G p �%^tn�1 /' <br />z- Z7a/co/�� <br />Oil U <br />aCw�.�l1,�LL• <br />// <br />f-41 A C InU) h I,064 - Y ycf l r � y 91 //W a <br />�r <br />Date of staff site visit: i Initials of site visit staff:117 <br />APPROVED BY LAND SERVICES OFFICIAL: — ATE:469 <br />UPON APPROVAL: AP IC ,-,NT 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 />< <br />b <br />CJ <br />(— <br />F <br />e <br />0 <br />o <br />r <br />o <br />� <br />w <br />d� <br />ro <br />o <br />0 <br />z <br />0 <br />-n <br />c <br />0 <br />a <br />a_ <br />Cn <br />4 <br />0 <br />c <br />" <br />na <br />a <br />d <br />� fio <br />�V <br />i <br />i� <br />t <br />x <br />d <br />i <br />i <br />C� <br />z <br />I <br />Fee Rec: j � <br />Check #: 8.3 <br />w <br />p7 <br />z Ste? <br />v� <br />c <br />c <br />m c <br />� <br />C=� o <br />