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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 />$300rAddition/Alteration <br />ion/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure <br />$300ion/Alteration <br />to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) <br />$150 <br />to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) <br />$200ion/Alteration <br />to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />house <br />$250 <br />Statute 59.692(1v) Structures <br />$350 <br />Driveways/ & Campground Structures <br />$125ate <br />Filling/Grading <br />$150house <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />1 <br />1 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: a ! f an ko Y-e. h <br />Property Owner's Mailing Address :2 d- F mwr- <br />City State <br />Property Site Address:a��44 t ill adl 12ogd F F I� r LN `_ ; Z <br />1-V3--+ o— " @VP <br />Contact's Telephone Number: <br />Contact's Email:gi�o — A L- 0 (Y61) • c oYY1 <br />Q <br />Legal Description of Property: �� Gs%''l V lO / Zk <br />Section #:! Town #: N Range #: Z 7 W Town of: b rt <br />*Attach additional page if neededfor 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): 25Z6 3 <br />Proposed Use of Structur ddition: g a-Ya 9-e- <br />Anticipated Start Date: -e dl �(� � q (Home/Cabin; Commercial Business; Bedroom; Deck; etc) <br />Building Contractor: 3 $ i�-, Sewer Installer: A/A <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />A) f �, �� Usk �� �u VA4h A'R �4�0& <br />CO Ci0 <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 />o <br />N <br />w <br />a <br />C7 <br />u% <br />o <br />d <br />y <br />C <br />N <br />'N <br />G <br />� <br />z <br />� <br />W <br />I�t <br />Fee Rec: <br />Check #: I I l�� <br />