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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line s <br /> a. <br /> Permit Types and Fees:(Please,check appropriate boxes) O <br /> i� <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 /> E <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 /> 0 e <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 I ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(iv)Structures $350 <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(i Year Extension-Allowed Once) $100 y <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. r- 3 <br /> o <br /> f <br /> Property Owner's Name: t G c7 ro< 1 c L� � <br /> Property Owner's Mailing Address: -1 oem-ei,' <br /> City Stater Zip E. <br /> Property Site Address: �!�- w e % � <br /> Contact's Telephone Number: � z � (fJ ew o a <br /> Contact's Email: ►''!I / Vq`'�l�t: l� <br /> Legal Description of Property: � 2 CS(h ✓ / 7 �L� CsL t,- o <br /> 0 _. <br /> Section#: I Town#: N Range#: /y W Town of. 02 Vv5 L � <br /> 0 <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): 0 <br /> Proposed Use of Structure/Addition: ,.+yrct <br /> x <br /> Anticipated Start Date: / C it�� ()Yome/Cabin:Commercial Business;Bedroom;Deck;etc.) ' C7 <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF CONINIENTS/CONDITIONS ONLY U �l <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z G <br /> Fee Rec: <br /> Check#: <br /> Date of staff site visit: O` I itial f site visit staff: <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: <br /> UPON APPROVAL: APPLICANT MUST POST COPY ON-313 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Transcendent: Page 1 of 4 <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 <br /> o <br />