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LAND USE PERMIT APPLICATION - Burnett County, WI bci <br /> a � <br /> Applicant Complete All Sections Below This Line ' <br /> a <br /> d <br /> Permit Types and Fees:(Please,check appropriate boxes) „ p <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 /> 3 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> r <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(I Year Extension-Allowed Once) $100 ` <br /> 0 <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 /> 1 0 <br /> Property Owner's Name: ► r�n l�Ir � rA�\1P_A.— ° <br /> Property Owner's Mailing Address: L40 S r1 ItE'f 1144, <br /> / City State Zip <br /> Property Site Address: /�L) (c`�c�`9 '� y � � p,�r.rN <br /> �, <br /> Contact's Telephone Number:,a 1`6—`J e Q -- —7 1 -7 / a <br /> ` d <br /> Contact's Email: tyA . VVI 01 CA10 <br /> Legal Description of Property: L-D" 1 C!S IVX V .25 ?c)G-7 o <br /> Section#:,;2 y Town#:_LIQ N Range#: W Town o£ s'Gc�'T w <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 /> o' <br /> Tax ID#(1-5 digit number;found on tax statement): 3 4 � <br /> Proposed Use of Structure/Addition: C(A Yam?i_e, k <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ° <br /> Building Contractor: /� Sewer Installer:¢r z,e,na C <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITTnNS LISTED BELOW: <br /> ti <br /> CGM OD le- ccc ed 1.:7 ' -POm <br /> CO\.knA-1 Rjj 10 ft s;de 5e* b4C-r-S <br /> e <br /> / y � Fee Rec:�� <br /> / � Check#: <br /> d <br /> Date of staff site visit: / Ini ' is of site visit staff: r <br /> a <br /> APPROVED BY LAND SERVICES OFFICIV )f — DATE: ! l <br /> r <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> m � <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o 0 � [� <br /> 00 CD C _ L <br /> Transcendent: - Page 1 of 4 o Q <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 1/2019 <br /> e <br />