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LAND USE PERMIT APPLICATION-Burnett County, WI b <br /> Applicant Complete All Sections Below This Line <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) w� <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 `D <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> G� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r `� <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $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. ro <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r. <br /> 0 <br /> Property Owner's Name: �, U► S T(� �c <br /> ^7 0 <br /> Property Owner's Mailing Address: 31 0 1 (&c/V nj -5' L= /� L. a <br /> p City State Zip <br /> Property Site Address: 3( 3 0 e C S T U"� (�Q < <br /> Contact's Telephone Number: (P I Z — Z S 7 60 W <br /> n. <br /> d <br /> Contact's Email: AN f 1 L u S't e2 A^y C, I cyC�e �U� <br /> Legal Description of Property: S e C )4/0(. i t:z <br /> Section#: q_Town#:�N Range#:�_W Town of: S L m <br /> b <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.' . <br /> 0 <br /> Tax ID#(1-5 digit number;found on tax statement): z Go <br /> Proposed Use of Structure/Addition: CA 13 W S C tf c tE N Pb il.C H -/0 <br /> Anticipated Start Date: '7-- (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o d <br /> Building Contractor: 0&.&4 A-, ,_ Sewer Installer: y C-r� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY pQ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: jV <br /> Ne�C,O 7v AaV-f, lOc�(�5 /HS a��Cd dH 5 t)O7�G. 7L4 n JtS z O <br /> I y q�i�zo�9. <br /> y Fee Rec: <br /> x <br /> C� heck#: 951,5' <br /> Date of staff site visit: Z / Initials of site visit staff: <br /> o <br /> APPROVED BY LAND SERVICES OFFICIAL: — DATE: PI <br /> CD <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF p <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT CD tom. <br /> Transcendent: - Page 1 of 4 a o <br /> cv <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 (� <br />