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LAND USE PERMIT APPLICATION—Burnett County, WI ro r <br /> a <br /> Applicant Complete All Sections Below This Line ' <br /> CD <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 <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 /> 0 <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 w <br /> a <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. C. <br /> 0 <br /> z <br /> Property Owner's Name: tTO N AI 0. J9A EfL-5T Kd M ° <br /> Property Owner's Mailing Address: 27E 7 Cot1A/ a f} S � y b <br /> City State " Zip <br /> Property Site Address:]7o CO u NTjI ROAD2. <br /> �/1��aS �r 1/V/• 7 f d �3 <br /> C H <br /> Contact's Telephone Number: 7/S J 6 O 5/ <br /> r7 <br /> Contact's Email: G f S S yy A an ►� <br /> l. C�r <br /> Legal Description of Property: �Z- 3 G/S o " <br /> Section#:z-.� Town#: N Range#:� W Town of: a <br /> r7 <br /> *Attach additional page if needed for lengthy description OR attachQa copy of the deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number;found on tax statement): �U7 <br /> Proposed Use of Structure/Addition: o X <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C7 <br /> Building Contractor:.Sttf;"f}n/ to LE 19�ZiLDi S Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z <br /> x Fee Rec: <br /> Check#:rri <br /> v <br /> Date of staff site visit. I Initials of site visit staff: a <br /> z --^.�—_ <br /> ^� r <br /> APPROVED BY LAND SERVICES OFFICIAL DATE: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> y <br /> r <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o N <br /> Transcendent: - Page 1 of 4 <br /> w <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 J(1t1 <br /> m � <br /> C7 J <br /> - j <br /> D <br /> 3 <br /> -o <br />