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LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> c <br /> Applicant Complete All Sections Below This Line c �a <br /> a <br /> Permit Types and Fees:(Please,check 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 \ O <br /> S Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 C) <br /> o <br /> � <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 jWl State Statute 59.692(1v)Structures $350 r "� <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 113ermit Extension(1 Year Extension-Allowed Once) $100 U <br /> *NOTE:After-the-fact permits(permit a uired 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 9 <br /> o z <br /> Property Owner's Name: 9 <br /> a o <br /> Property Owner's Mailing Address: i �; � <br /> City State <br /> Property Site Address: I �^� -14 �, _� < <br /> o N <br /> Contact's Telephone Number: 7� ?2 �I �� 771 <br /> Contact's Email: W Q e-r of es G q W►Gt t�f r G O tin <br /> Legal Description of Property: G 619 ✓`f <br /> Section#: Town#: 412 N Range#:__jj�_W Town of: CAR q as <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page. <br /> Tax ID#(1-5 digit number; found on tax statement): 6'rs-- <br /> Proposed Use of Structure/Addition: 4 p s V�/VJ U 1 r�QT <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) p <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF CO3INIENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 61 <br /> " sPe �/ S �� � � O <br /> � <br /> � S�GFl 1�1i1 U S� l�1� G�` s re-lb C-tj aGt� �'!O�7� <br /> /.ti/ Se �✓' U "A Cr N Fee Rec: Z�iJ< <br /> heck#: /0 2- q <br /> Date of staff site visit: �P l� / / Initials of site visit staff: �JZ5-ck*7�D/ <br /> g o <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: 7 Z0/Z <br /> a <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ;m <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ? " <br /> m � <br /> me N <br /> Transcendent: - .'c"' a <br /> Page 1 of 4 � 3 ca <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 <br /> a <br />