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LAND USE PERMIT APPLICATION - Burnett County, WI <br /> Applicant Complete All Sections Below This Line <br /> a. w <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 Z)o CO <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° G <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r- <br /> o <br /> Filling/Grading $150 1 lBoathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 1 jPermit Extension(1 Year Extension-Allowed Once) $100 <br /> m <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. <br /> Property Owner's Name: c °�u5�a-g�o1nl13, '1� f�l z o�1 c.�old ���. <br /> Property Owner's Mailing Address: oo\.& 1 rj74 I} nl- ��/C a <br /> n City State Zip ram„ <br /> Property Site Address: �73 �auU.-�(1�`Q. V(� (�,Ti,/. <br /> Contact's Telephone Number: $ ' a� -7o*O V r <br /> Contact's Email: �1 1 � • Cory, <br /> Legal Descri tion of Property:''1 �1 rl —allow Kof-�4550S&r� 91A.� 1-*d"43 o-SHQ1`4 oo4 o o� <br /> Section#: 7 Town#: i N Range#: R is W Town of: j S <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): ?o( <br /> Proposed Use of Structure/Addition: h•'(dA.R� x <br /> Anticipated Start Date:A6 so e h As eg fa JomelCpbin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: jam, Sewer Installer: O <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> � I'll.EcSvCi Gar (CWVc, o-f applu_ � <br /> y►�tfctl�. � �ov�EaiK.ty� �� 1a�i�a.oi9) <br /> I&Av kau.se 15-0�= Fee Rec: <br /> Check#: <br /> 0 <br /> Date of staff site visit: tj Initials of site visit staff: a <br /> z <br /> d <br /> APPROVED BY LAND SERVICES OFFICI . 1 ATE: <br /> UPON APPROVAL: APPLICANT 1V UST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> yN <br /> n Transcendent: - N <br /> Page 1 of 4 c <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 1/2019 3� o <br />