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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> Applicant Complete All Sections Below This Line ' <br /> CD <br /> a a }�? <br /> Permit Types and Fees:(Please,check appropriate boxes _� a <br /> Dwelling/Principal Structure $300 4V Addition/Alterationto Dwelling/Principal Structure $200 �_ I <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �+ 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150CD <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(1v)Structures $350 <br /> r <br /> Filling/Grading $150 Boathouse <br /> $500 i^ <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(I Year Extension-Allowed Once) $100 <br /> w <br /> 0 <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. C <br /> J z <br /> Property Owner's Name: gr am- A(AT.ACJe)• �' QJ•i �i?C{���1 � rl <br /> Property Owner's Mailing Address: <br /> City StatV Zip R. n <br /> Property Site Address: <br /> Contact's Telephone Number: �p�— S- 3?3 a <br /> Coin s�.n e f <br /> Contact's Email: 11-5 e 03 �y 2 <br /> Legal Description of Property: p �S Q /�'.7pp/09� C <br /> Section#:�,�Town#: N Range#: A 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): 3� (j CIO <br /> Proposed Use of Structure/A dition: <br /> Anticipated Start Date: (Home/Cabin;Commercial usmess;Bedroom;Deck;etc.) � C7 <br /> h rit G i�f�, Sewer Installer: / y Building Contractor: � p j' � <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z � <br /> �C+�(� SGL1I�fG!^ l7/ lei SRN 0�1M1�f �SO ?7 <br /> y <br /> Fee Rec: <br /> Check#: <br /> 0 <br /> Date of staff site visit: ��� Initials of site visit staff: r <br /> a <br /> _ r <br /> APPROVED BY LAND SERVICES OFFICIALATE: <br /> UPON APPROVAL: APP CAN UST POST COPY OF a <br /> �- <br /> CO 03 <br /> C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> y0 a <br /> -< 00 <br /> Transcendent: - D 3 c <br /> Page 1 of 4 ,� <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 <br /> d '^ <br /> a <br />