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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> Applicant Complete All Sections Below This LineCD <br /> o. <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 IPQ <br /> 0 <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 N ti <br /> Accessory Structure(Commercial/industrial) $200 Addition/Alteration to Bunkhouse $150 U1 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> r <br /> Filling/Grading $150 I Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension R Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ro <br /> *Items not listed above will be treated as <br /> Il accessory <br /> ysstructures,such as:pergolas,landscaping,etc. � <br /> Property Owner's Name:�ipj\4 4— <br /> m <br /> w _ 0 <br /> Property Owner's Mailing Address: 2� `` �� !''p l e-, o < v �Ss to ba <br /> City State Zip <br /> Property Site Address: ;?n.D 0 k t, t I1 (o <br /> — <br /> Contact's Telephone Number: l$ �pZ 3 t' a qva (D L <br /> d <br /> Contact's Email: C0 6", <br /> Legal Description of Property: OrCl <br /> Section#: Z�Town#:��N Range#: Town of: �— <br /> t7 <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:79C <br /> Anticipated Start Date:"fib 6j� A Z it a o(-QI (Home/Cabin;Commercial Business;Bedroom;Deck,e�tc`,)� tj <br /> g /a `� �1 a G <br /> Buildin Contractor: Sewer Installer. y� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CON% TIO S ONLY 7 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> e�X reibuue- or aPP(�- for a Per�.�t , -far tht <br /> va4t,t Clvr cove+aivt,Gr (91 <br /> ivt,5PtC.+w(' -rnr &vt,k-h4tA5t 54-ritic+uCC. <br /> Fee ReCAo9 50.00 <br /> Check#: 35$ <br /> Date of staff site visit: 40/1 Initials of site visit staff: <br /> APPROVED BY LAND SERVICES OFFICIAL• <br /> UPON APPROVAL: APP CAN UST POST COPY OF o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Transcendent: - <br /> Page 1 of 4 <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 <br /> y <br /> •-3 <br /> a <br />