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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> a <br /> Applicant Complete All Sections Below This Line o <br /> Permit T es and Fees: Please,check a C7 <br /> Yp ( appropriate boxes) .. <br /> Dwelling/Principal Structure T$200 <br /> Addition/Alteration to Dwelling/Principal Structure $200 161, <br /> Commercial/Industrial Structure Addition/Alteration to Commercial/Industrial Structure $200 O <br /> )( Accessory Structure(Garage,Shed,etc.) Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) Addition/Alteration to Bunkhouse $150Deck/Stairs/Patio/Retaining Wall/SidewalkBunkhouse $250Driveways/&Campground Structures WI State Statute 59.692(1v)Structures $350Filling/Grading Boathouse $500Six Month Camping Unit(One Per Year) 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. Ly <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. c <br /> ® !7• .r, o <br /> dq�- <br /> Property Owner's Name: /v v o i <br /> Property Owner's Mailing Address: 65-'?'6 i10�A -�7� �o fk'�G,-�,,, ou 5SOA� v°' <br /> City State Zip <br /> Property Site Address: Z93?y Z Ai 114yA1ef1 Zi & t/-)z 5y,930 � <br /> Contact's Telephone Number: ,725/-2328 <br /> � a <br /> dContact's Email: /h 3c•Ae.��s-�� Loryl � <br /> Legal Description of Property:_ 1� - /�a�,ca✓t� �,�� �o7E o <br /> YO <br /> Section#: Oil Town#: S/Q N Range#: //a W Town of Qc./�IavLei <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> 5. <br /> 0 <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: Alm <br /> Anticipated Start Date: CD c:7o Z eG - (Home/Cabin;Commercial Business;Bedroom;Deck;etc) C7 <br /> CD <br /> Building Contractor: Sewer Installer: Co <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTSICONDMONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: O <br /> a� h I' 1�1c'n0.+� `-�-c�A-t Q z <br /> t [r'11 � � <br /> Fee Rec: I <br /> Check#: l i-733 <br /> Date of staff site visit: � © Initials f site visit staff: \ r <br /> APPROVED BY LAND SERVICES OFFICIAL: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a G� <br /> CD W <br /> (� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z <br /> Transcendent: - o <br /> Page 1 of 4 W 3 w <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 2 <br /> d `0 <br /> N <br />