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LAND USE PERMIT APPLICATION—Burnett County, WI b <br /> Applicant Complete All Sections Below This Line ' c o <br /> c <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 —V <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 /> o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 � <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 C- <br /> o <br /> Filling/Grading $150 113oathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 1 jPermit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fad 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 /> _ z <br /> Property Owner's Name: ./IJ{J LO- J GL 44.1 C,LA- <br /> Property Owner's Mailing Address: /1 CiVAJIk IvQz6le'r 4dl S1993 a <br /> / City State Zip 5 <br /> Property Site Address: 5W 5 6 7 3�—'� ��/V '-11Zj Tj A/J �a `7 o y <br /> Contact's Telephone Number: CL <br /> Contact's Email: J 6L 3 -7c:)-� ^5/C.) WK <br /> Legal Descriptio?Town <br /> Property: .S S "'7 7 1/(�/ \ (�' 0 04 <br /> Section#: #:__qLN Range#: W Town of: <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> o' <br /> Tax ID#(1-5 digit number;found on tax statement):_ p� <br /> o <br /> Proposed Use of Structure/Addition: p <br /> Anticipated Start Date: C� / (Hom abin;Commercial Business;Bedroom;Deck;etc) C7 <br /> Building Contractor;-Q p LC41 41'4 d) Sewer Installer: <br /> AREA BELOW THIS LINE FORLAND ND SERVICES STAFF COMMENTS/CONDITIONS ONLY r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: `f <br /> . �o ��J �e-�. --lCS z <br /> 1 <br /> II-- � <br /> "t <br /> Fee Rec: <br /> r� <br /> y Check#: <br /> 3() �aa� <br /> Date of staff site visit: Initials of site visit staff: <br /> z <br /> APPROVED BY LANDS RVICES F ICIAL: DATE: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 3- <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT W N ^ <br /> r w :2 n' <br /> Transcendent: - Pa e 1 of 4 `D g cN� <br /> 9 e! <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 3 <br /> v CD <br /> a <br /> i <br /> b r <br />