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LAND USE PERMIT APPLICATION - Burnett County, WI r <br /> � c <br /> Applicant Complete All Sections Below This Line c <br /> Permit Types and Fees:(Please,check appropriate boxes) d p� <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 C) <br /> G) -r> <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 r <br /> o <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 w i0 <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 /> Property Owner's Name: Buck }%c Cam, �LACI& <br /> Property Owner's Mailing Address: Z Z MM C W <br /> City State Zip <br /> Property Site Address: 7,9 79 9 M1,yewli9 Gt/2 Dmvbc., Wr5 y8'3z) <br /> o <br /> Contact's Telephone Number: 7/37-- ?9/' D D�/g <br /> a <br /> b � <br /> Contact's Email: 11-21,CA_h. i�ae, �sU to D. GO VU\ c� <br /> Legal Description of Property: L01 Z, C S MAW/98 92216PO 40T J 56(-35 NW 514/5616 13 41) o <br /> � �_� g �� ;SQ) 1`5� 152i1, <br /> Section#: .,S_J-S/_Town#: N Range#: W Town of: � <br /> -mac-� t� <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): J 2,34 3 <br /> Proposed Use of Structure/Addition: -66A-�' $�"2 i x <br /> Anticipated Start Date: (Home/ Commercial Business;Bedroom;Deck;etc.) ° tj <br /> Building Contractor: Sewer Installer: N O 1V 1✓ <br /> �--� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 4S 6- <br /> ---------------- <br /> Fee Rec: lk�� <br /> Check#: <br /> Date of staff site visit: ( ✓ Initi of site visit staff: a <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: / <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> A <br /> c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT N [� <br /> O G7 <br /> Transcendent: - Page 1 of 4 Q <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 (jl( <br /> d <br /> a <br />