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LAND USE PERMIT APPLICATION - Burnett County, WI b <br /> Applicant Complete All Sections Below This Line <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 S>Q <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 /> G� <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 Boathouse ° <br /> $500 <br /> 10 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. �u <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. C. <br /> Property Owner's Name: C-scw LoS-t N-.tSiy© a (^ o ° <br /> 10 <br /> Property Owner's Mailing Address: 3 S0 '�`a�` C�c Ne !" 0 fu 1J <br /> �25 12 Ojest PI 1T l /t Ld D Ci Y � State Zi <br /> Property Site Address: J �t P CW �+l ,= S t[ 3 0 � <br /> < <br /> Contact's Telephone Number: 612 VO 6 �73 a l' 6 12 Z YO 7 o a <br /> Contact's Email: >`I 4 S C � iAA$to i C O vl--1 <br /> w <br /> L � <br /> Legal Description of Property: 4C pL S 0 V\ UYff L a F e o <br /> Section#: Town#: N Range#: W Town of: ( 0AIJ 67 A,' <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a cop 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:. �i V- PC1_1 Iv I -Ic7 r_ <br /> Anticipated Start Date: �� I -t (Rom Cabi C64ercial Business;Bedroom;Deck;etc.) E5 <br /> a � o l' S Sewer Installer: <br /> Building Contractor:A-MPr'cct tLsjP@I .p <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> ULi <br /> z � <br /> z <br /> W <br /> = Fee Rec: <br /> (y Check#: <br /> (XJ <br /> Date of staff site visit: O"" I ' 'aIs <br /> of site visit staff: a <br /> ?� <br /> APPROVED BY LAND SERVICES OFFICI DATE: � J <br /> UPON APPROVAL: APP ICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 2� <br /> Transcendent: - Page 1 of 4 �' Q <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 c� <br /> .. <br />