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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 />Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) <br />f$200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/SidewalkBunkhouse <br />$250 <br />Driveways/ & Campground Structures <br />WI State Statute 59.692(1v) Structures <br />$350 <br />Filling/Grading <br />Boathouse <br />$500 <br />Six Month Camping Unit (One PerYear) <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: V �� <br />Property Owner's Mailing Address: �� `A- C\ c-C <br />ty State Zt'p <br />Property Site Address: %�� <br />`fS9 <br />Contact's Telephone Number: <br />Contact's Email: �G�J ; d.cxy <br />Legal Description of Property: 0t �•'<Y,�i �X / <br />Section #:�_ Town #: N Range #:�_W Town of.— ' y(fjl,l <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): pZ �j 4s <br />Proposed Use of Structure/A ition: G 11<C1-0A-P— I s\--\ Qie <br />Anticipated Start Date: (Hom /Cabin; Commercial'*Business; Bedroom; Deck; etc.) <br />Building Contractor: Sewer Installer: <br />Al\LA LIiLV ♦♦ 1111J L1:\r. 1'Vl\ LA��L Jr. i% II. GJ Jliirr I r,l413/%-"iNU111",Nn V1VLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONSS LISTED BELOW: <br />r/l a 5 aw 7/ �Ie /O <br />�yf'�p®d' 51�1�LJf� des'! A— 94P,11N /Yn°44 <br />Zoe— <br />MWO Ok- <br />7�`� /.J1740 <br />;Z�- l �Q y sys ' y <br />91,12019 <br />— IVo7"- Tv d e. <br />US eo/ <br />U vet a N <br />Date of staff site visit: ' 3 / Initials of site visit staff: i 7/ <br />APPROVED BY LAND SERVICES OFFICIAL: DATE: <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 />r, <br />0 <br />IS <br />z <br />z <br />Fee Rec: LS(l - <br />Check #: ,29�2CAD <br />r <br />w <br />a <br />�w <br />t� <br />C <br />6 <br />m- <br />r <br />%.Z <br />N <br />O <br />m <br />Ga <br />