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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 />WI State Statute 59.692(ly) Structures <br />$350 <br />Driveways/ & Campground Structures <br />$125 <br />Filling/Grading <br />$150 <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$10o <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: Q f1 �Jr�y +^ 1� % 0- ►1Ac 6 ,v 15 0 <br />Property Owner's Mailing Address: b lj' K (4 (4 6 u,,/, LT S-1 ys- } <br />/� City State Zip <br />Property Site Address: � j .�; hnc,n ye�h�t l� tI' GJ ab--i- Y� r, <br />.5 <br />Contact's Telephone Number: % t 5- 3 -- (/ A <br />Contact's Email: f- % > cp 5 C d 1 e,,J , <br />Legal Description of Property: [ 1) ♦ j CSm SS y' or c <br />Section #: Town 4:__40 N Range #: W Town of:_ OC',K)C,n <br />*Attach additiona/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): lJ! 3 <br />Proposed Use of Structure/Addition:y.Q..0 <br />Anticipated Start Date: (Home/Cabin: Commercial Business; Bedroom: Deck: etc) <br />Building Contractor: Sewer Installer: <br />AREA BELOR THIS LIME FOR LAND SERN ICES STAFF CONIMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Date of staff site visit: 7 Z 1 Initials of site visit staff: A r, <br />11 APPROVED BY LAND SERVICES OFFICIAL: DATE: 7 <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 />N <br />0 <br />0 <br />c <br />2 <br />o <br />1 <br />c <br />G <br />�ro <br />� C <br />A <br />z <br />z <br />W <br />Soo <br />Fee Rec: <br />Check <br />#: 165ft " <br />r <br />nt <br />CDC <br />2 <br />ICJ <br />CD C <br />cz <br />co <br />C3`e <br />