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LAND USE PERMIT APPLICATION — Burnett County, WT a <br /> Applicant Complete All Sections Below This Line s �a <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> rn <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 ti <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 U� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 r- <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One PerYear) $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. r <br /> 0 <br /> 1 " z <br /> Property Owner's Name: Qt 0 <br /> Property Owner's Mailing Address: fix/ S S D U ) ' LcJ I SA) 3v <br /> City State Zip <br /> Property Site Address: -S q'll"F- <br /> / o <br /> Contact's Telephone Number: S>t 36 <br /> 0 <br /> Contact's Email: C <br /> Legal Description of Property: <br /> Section#:)_Town#: ri/o N Range#: le, 1 W Town of:_ }�/p�j <br /> 0 <br /> *Attach additionalpage 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): <br /> Proposed Use of Structure/Add'tion: s���L�l /�G g C X <br /> Anticipated Start Date: 5 Z0 9 (Home/Cabin;Commercial Business;Bedroom,Deck;etc.) ° p <br /> Building Contractor: ;V#JL IT2. 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 /> � �p� -F0�' HUUMGU/l ��Jorfa-�rbvt z <br /> Fee Rec: 15 0W <br /> Check#: <br /> 0 <br /> Date of staff site visit: AInitials of site visit staff: <br /> APPROVED BY LAND SERVICES OFFICIAL: Gjz��TE: !' o <br /> D <br /> UPON APPROVAL: APPLICAN MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHTCn <br /> CM <br /> Transcendent: - K c.0 <br /> Q <br /> Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 -- --� <br />