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LAND USE PERMIT APPLICATION— Burnett County, WI I r <br /> < b <br /> Applicant Complete All Sections Below This Line ' <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 /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> G� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 C. <br /> Filling/Grading $150 1 113oathouse $500 ° <br /> Six Month Camping Unit(One Per Year) $100 1 Permit Extension(1 Year Extension-Allowed Once) $100 <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. CD <br /> not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o CD <br /> � ,,,,� z <br /> Property Owner's Name: ��%S M�G�1GG� <br /> / 94 t� a <br /> Property Owner's Mailing Address:�� V e' 1oil 64 �J cl r n'10 <br /> Ci State Zip <br /> CIO <br /> Property Site Address:gq741 <br /> �,-w-C4 L I <br /> , o <br /> Contact's Telephone Number: ' o� 4 ' ,3 q a <br /> Contact's Email: \( Lk Vk YL\'()q 4 • Can-, <br /> Legal Description of Property: 6� c <br /> Section#: _Town L-�__N Range#: t; W Town of. vu i S <br /> t7 <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: C!�eC <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc) C7 <br /> Building Contractor: Sewer Installer: <br /> - N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> LlI;fie s O P oih Asi y>o c-o V z <br /> ,�L7�4'�d� • <br /> Cr L <br /> x Fee Rec: � 5 <br /> Check#: <br /> Date of staff site visit: / /9 Initials of site visit staff: <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL: �..- __�— -- DATE: ? � Z0� <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF <br /> c� — <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT = r <br /> ,0 <br /> Transcendent: - 0 av o <br /> - --- Page 1 of 4 Q <br /> Laserfische: - _ Burnett County,WI Land Use Application-Rev 1/2019 ` — Q <br /> a <br /> rof <br />