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LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> a � � <br /> Applicant Complete All Sections Below This Line <br /> is <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 l7 <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 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 r- <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: +1✓tS p�'►-�✓ 6c LAiIYA- E)P4 z <br /> 0 <br /> Property Owner's Mailing Address: 3 ; — hl,, A vd ept Wilt A d 5Pt 7 <br /> -�" State Zip <br /> Property Site Address:Z�{�81'o CAI'I�t,�OGt�LGiJtsf�n (�{�p�a �. 5t{Rl 3 <br /> rw r• � H <br /> Contact's Telephone Number: W S-1• �(/ 14 P o a <br /> n I o <br /> Contact's Email: , Y t S� [:1��L• 1® �d✓►4.('t'�/'R K H Lf;►- ( C°wl <br /> Legal Description of Property: X-l" S 6 N <br /> Section#: S' Town#: 3 N Range#: i 5 W Town of: iT {t41 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach taz system property page. <br /> Tax ID#(1-5 digit number; found on tax statement): <br /> Proposed Use of Structure/Addition: be e k o x <br /> d Antici ate Start Date: <br /> p >�s p1� (Home'Cabin:Commercial Business;Bedroom;Deck:etc.) � p <br /> Building Contractor: 141 A Sewer Installer: nl 1 A _ <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY G <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> • 'Folto� F�no k �eSiSn � �Xa-�� T ' Aec.K lad-er0.1 , A n U► <br /> r- nn . . R-�CPgr�$rOrl <br /> Lj <br /> a�- <br /> .� Fee Rec: <br /> s <br /> � y Check#: 0-A(1- <br /> Date of staff site visit: l ^o^�`- ✓"—c Initials site visit staff: a <br /> c CAD <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: <br /> � a <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 4 0 CO <br /> > C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT " m w Guy <br /> Transcendent: - 0 <br /> Page 1 of 4 ! Q <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 3 <br /> b <br />