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LAND USE PERMIT APPLICATION -Burnett County, WI a C b <br /> Applicant Complete All Sections Below This Line <br /> CD <br /> Permit Types and Fees:(Please,check appropriate boxes) w� <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 CO <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 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 jWl State Statute 59.692(ly)Structures $350 C• <br /> Filling/Grading $150 1 113oathouse $500 <br /> Six Month Camping Unit(One Per Year) $100V jPermit Extension(lYear Extension-Allowed Once) $100 <br /> w <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. <br /> z <br /> Property Owner's Name: 2 J� A a /2 / T L ° <br /> 0 <br /> Property Owner's Mailing Address: Z c�r 7 7 A104/L bl?r 3 ye-so $ <br /> City State Zip <br /> Property Site Address: Z9 7 9 7 <br /> o <br /> Contact's Telephone Number: 715- 715-/y y S g <br /> // // d <br /> Contact's Email: mC0A)ST/LecC.t4eA,', C411 6 6�l a /, Cvm ° <br /> Legal Description of Property: v.t Z [_S/�� (/ /7 /� `�cCS (AL)C A)W) o <br /> Section#: .5l q Town#:`r�C A) N Range#: %Z/T W Town o£ UA)io,y <br /> C7 <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): z17g3 <br /> Proposed Use of Structure/Addition: e, 4i2 17,,r o <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc) C7 <br /> Building Contractor:—;t/&)/7 5:1j- s Sewer Installer: C <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> otd a5 kUUW-v� �lalo,TCXX7 <br /> Fee Rec: !� <br /> 14 <br /> Check#: .26 ao <br /> 0 <br /> Date of staff site visit: /S 0/1 Initials of site visits ff: a <br /> z <br /> APPROVED BY LAND SERVICES OFFICI 4 —/ <br /> GV1G DATE: <br /> m �? <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a) G �! <br /> a c� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o (A 0 <br /> 00 <br /> Transcendent: Page 1 of 4 C <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 m U <br /> a <br /> ro <br />