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LAND USE PERMIT APPLICATION—Burnett County, WI r <br /> a � <br /> < b <br /> Applicant Complete All Sections Below This Line ' <br /> C <br /> a. <br /> Permit Types and Fees: Please,check a \ C7 <br /> yp ( appropriate boxes) „ <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <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 /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 <br /> Filling/Gradingr <br /> $150 Boathouse $5p0 ° n <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 ,�' D— <br /> *NOTE:After-the-fact permits(permit squired 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. r. <br /> 0 <br /> Property Owners Name: <br /> ,r� a <br /> Property Owner's Mailing Address: - 4 712 (I r e 5 u� /t /L'/ ' Z,r 1�-Fyy $ <br /> City 9tate Zip <br /> Property Site Address: > <br /> Contact's Telephone Number:_ 71-57- 2 26 G 91t Sf o 0 <br /> d <br /> Contact's Email: d yn, C r tO._� C j►�1 C eJ y <br /> o <br /> Legal Description of Property: '?iA Lq,ke S` b ar 7 N <br /> Section#: wn#: N Range#: /Jr' W Town of:_ <br /> r7 <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 /> Proposed Use of Structure/Addition: t"u�j Z=e.�..S�j��� o <br /> Anticipated Start Date: 3-u j y 2-0 -YHome/Cabin;Commercial Business;Bedroom;Deck;etc.) C7 <br /> Building Contractor: Sewer Installer: y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> a 5 u ye f to P" e. /o f f- 6l ol� 5eAack, z �1 <br /> (5r a✓'u 4 e,/Sl?e Q A o 74- 7�> !D 2 Lt S 2¢' Tb r �f U vvJci Al 4cr <br /> ti Fee Rec����(J " <br /> x <br /> Check <br /> (� o <br /> Date of staff site visit: ? �-7 / Initials of site visit staff: �� a <br /> z <br /> v <br /> APPROVED BY LAND SERVICES OFFICIAL: <br /> r----- DATE: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OFCD <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT00 <br /> -- <br /> Transcendent: - M r- N o <br /> --- Page 1 of M 0Q - C� <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 < C <br /> o <br /> a �� <br />