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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(1v) Structures <br />$350 <br />Filling/Grading <br />$150 <br />1 <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 1 <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 ( ! I �� .f [ <br />_ <br />.3 1 <br />Property Owner's Mailing Address: 9� /7 T l� Q 3 &-4 l 6jh vLv NS 042 00 T s 46J- <br />City State Zip <br />Property Site Address: AM <br />Contact's Telephone Number: ! 1 " ' q q — 2� / <br />Contact's Email: I-2e• W �y tr111T1- <br />Legal Description of Property: C , , a-ki d <br />Section Town #: % � N Range #:—/(P_W Town of: <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 />(� <br />Proposed Use of Structure/Addition: /ACC,—fy ( © (, ; ► LL 5 ���e-. P6vt. TCRmn r'!� 06z- <br />Anticipated Start Date: �u (� , !j-,( t (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: Iva l at-c'4-e1) yt-71--1 Sewer Installer: 6, <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF CONINIENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO CONDITIONS LISTED BELOW: <br />/ALL <br />i 5 ► r�v�e� r�l c�e f e S cp4 c-�S <br />o� ld * o '.-k 7,Ae- s� /i��- a�� G3 f-14- <br />� <br />9l 1l 20 <br />y <br />Date of staff site visit: 7 3 Initials of site visit staff: <br />APPROVED BY LAND SERVICES OFFICIAL: DATE: % S <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 />d <br />� <br />d <br />� <br />F <br />C� <br />o <br />� <br />r <br />c <br />r <br />0 <br />z <br />0 <br />ti <br />0 <br />0 <br />o <br />o <br />ac <br />5' <br />ro <br />d <br />v' <br />o � <br />F x <br />� C7 <br />G <br />O <br />z <br />Coe <br />Fee Rec: <br />Check #: q2L- <br />� �U <br />z <br />m 03 <br />a <br />FM <br />Z l4 a'J <br />> <br />n M <br />N <br />y nCD <br />�a <br />z <br />00 <br />r- <br />-0 aca <br />_ o <br />!� Q <br />cs <br />3 <br />(;mil <br />m <br />c <br />3 <br />