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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 />, <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 />ccessory Structure (Garage, Shed, etc.) <br />$150 <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Driveways/ & Campground Structures <br />$200 <br />$125 <br />Addition/Alteration to Bunkhouse <br />Bunkhouse <br />$150 <br />$250 <br />WI State Statute 59.692(1v) Structures <br />$350 <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 />$100 <br />*NOTE: After -the -fact permits (permit aquired after construction has begun) may cost up to three times the normal fee. <br />*Communication Towers & Signs require a different application form; see corresponding application, and fees. <br />*Items not listed above will be treated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: k &e-- t 4 Ar,..„tj" <L ,. z. % p ,, <br />Property Owner's Mailing Address: 2—O 30 1-17b� <br />Property Site Address: 2$ I a l 111, <br />� t &J,_ ems. M4 s <�,] <br />tate Zip <br />Contact's Telephone Number:�j <br />Contact's Email: C, c� �� �'t5 l y\ <br />Legal Description of Property: 0 41{,u. a,Section#:- /I Town #: N Range #: & W Town of: Qs`K � qVJ <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): <br />Proposed Use of Structure/Addition: 49 ak rc;,orr\ AA ro <br />pm <br />Anticipated Start Date: (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: A/ .wry ` <br />r � ��,�� Sewer Installer:_ �. yl <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />/uo a 441 n a 6e.QlY`oo 0,1t5 i n 7e_ 40 1 1 11� . <br />Date of staff site visit: Initials of site visit staff: <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 />< <br />� b <br />d <br />o <br />70 <br />r <br />0 <br />0 <br />r <br />o <br />� <br />r: <br />z <br />0 <br />0 <br />iv <br />o <br />, <br />c <br />a <br />0 <br />N <br />5" <br />o� <br />0 <br />X <br />❑ O <br />K>9 <br />z <br />Fee Rec:Z <br />U <br />U. <br />Check #: �G <br />r— <br />m <br />a <br />COCO <br />CD <br />v0 <br />Uir <br />o <br />w <br />o <br />m <br />