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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 />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 />IS100 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />Permit Extension (1 Year Extension - Allowed Once) <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: thQ1ras olse„ <br />6765 Buckingham Rd <br />Property Owner's Mailing Address: Woodbury, MN 55125 <br />City State zi <br />Property Site Address: a"�f UC a� N wieL ,• i� L W i S q $' 9 3 <br />Contact's Telephone Number: 1P!5 `—"1 DD ' I jo <br />Contact's Email: !� S ��yy '-k Jt`"CO • C i 1 M <br />L OLo lK q, 5 i FiT�S <br />Legal Description of Pro a <br />g p p rty: LOT r ,, l 1" (a i NT IN 0t-M L C:TS i �4- Q <br />Section #:)4w% Town #:_DN Range #: 16 W Town of: OftKLNk b <br />*Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system property page.* <br />) q� —+ <br />Q <br />Tax ID # (1-5 digit number; found on tax�statemeenti. <br />p <br />Proposed Use of Structure/Addition: 1 v A (N j}7' & 1 L. D \Xf 1 l-L— 6,A) !��{ <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 />Rc4m,,ve, 1g0d1s"fe. boQY4 {-row► �e- /4� <br />by $/)120�9. <br />/ _ l <br />Llnor/v1 QjAdl loc.K� l �'1 5��� dGt ���Q�1✓ <br />�14,k by <br />Date of staff site visit: Initials of site visit staff- <br />APPROVED BY LAND SERVICES OFFICIAL: DATE: ZO <br />UPON APPROVAL: APPL CANT 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 />A <br />z <br />Fee Rec: L� <br />Check #: <br />— <br />lJ IJ <br />r <br /><� <br />.m <br />C) <br />N O <br />r= <br />o v <br />CO <br />