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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> Applicant Complete All Sections Below This Line ;o <br /> a <br /> t7 <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> CD <br /> Dwelling/Principal Structure V3Adtion/Alteration to Dwelling/Principal Structure $200 Cl� <br /> Commercial/Industrial Structure tion/Alteration to Commercial/Industrial Structure $200 <br /> f <br /> Accessory Structure(Garage,Shed,etc.) ition/Alteration to Accessory Structure $150Accessory Structure(Commercial/Industrial) ition/Alteration to Bunkhouse $1504�Deck/Stairs/Patio/Retaining Wall/Sidewalkkhouse $250Driveways/&Campground Structures tate Statute 59.692(1v)Structures $350Filling/Grading house $500Six Month Camping Unit(One Per Year) mit Extension(I Year Extension Allowed Once) $100 �' <br /> �a <br /> *NOTE:After-the-fad 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. CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> ( • ' '' L�J��i�uh r <br /> ProPerh Owner's Name: 091 o I o <br /> Property Owner's Mailing ddress: i f. <br /> City State Zip <br /> Property Site Address: l (�--t_'�ir'�C.. `a�� �l�Cd L-.t <br /> o <br /> Contact's Telephone Number: �r 5y~ l.b� <br /> yj �� <br /> i wv <br /> Contact's Email: iA V l f-!r �_ koTyv-ex.l CD <br /> Legal Description of Property:,5e-C .) 2- �^3'� y ! S W` zo P174 / �67 Al uo <br /> Section#:3z Town#: N Range#: I E,) W Town of- /W(,C— <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 /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: OAA-�-11 ° x <br /> Anticipated Start Date: UL16 (Home/Cabin;Commercial Business;Bedroom;Deck;etc) <br /> t <br /> Building Contractor: Sewer Installer: <br /> 4 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Nj <br /> Savet v' e ryo+�•l'7L IS -�v' Z h e�yb o'm s J o u t e �Al4�t5 <br /> S�ilvW y ha-rno P0 S . <br /> Fee Rec: <br /> Check#: <br /> 5 <br /> Date of staff site visit: Initials of site visit staff: ) <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Q a -- <br /> < 3 <br /> Transcendent: - 5.Page 1 of 4 �Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 0 0 ,� o <br /> CD � . <br /> w <br />