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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 />lo"Dwelling/Principal <br />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 />1 <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 />jWl State Statute 59.692(1v) Structures <br />$350 <br />illing/Grading <br />$150 <br />lBoathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />1 <br />Permit Extension (1 Year Extension -Allowed Once) <br />$100 <br />*NOTE: After -the -fact permits (permit aqui red 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 W EftdAJ <br />Name: AAk <br />Property Owner's Mailing Address: 1 1914L JfLirj4 91j&vx % 1A) 'l <br />State Zip <br />Property Site Address: '41 j _y pelA ' FyeJ*,,L w,iCity L� � <br />�It <br />Contact's Telephone Number: vl e L+OAi 1 �j rj.) L — -11 9 <br />f' <br />Contact's Email: LAb0S".;0P k-% MP NV AJQ M41 (t)j4--7 <br />Legal Description of Property: r P <br />L i� �► <br />Section #: Town #: _N Range #: W Town of: 4 j;j Ile f% <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): 3i <br />Proposed Use of Structure/Addition: i- A D,A) <br />Anticipated Start Date: I j Ij'( I I (Home/Cabin; Commercial Business; Bedroom; Deck; etc) <br />Building Contractor: LA) M4 WM k u t p/� 0 L Sewer Installer: }dc k f1w%-1bi&i� <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />/PERMIT <br />5cc to I' TQ e y (l`2-�� GI Ul e c T P ems✓` ►n� rf ' a pPy0V 2,1 04 <br />7//0/Z0�9, / <br />Date of staff site visit: � / Initials of site visit staff: / <br />APPROVED BY LAND SERVICES OFFICIAL: DATE: % /d % <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 />Fee <br />r <br />b <br />z <br />0 <br />C7 <br />w <br />rn <br />b <br />x <br />� e <br />W <br />Rec:�� <br />Check #: / F6�, -_) <br />C <br />a <br />0 o <br />L� <br />"0 <br />m <br />�( <br />