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LAND USE PERMIT APPLICATION - Burnett County, WI <br /> r <br /> Applicant Complete All Sections Below This Line 4 <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) � I <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 4 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 U <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $20 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° t <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 �- <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 d <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 /> o <br /> Property Owner's Name: l,C% L, !�t<Y`1 °° <br /> Property Owner's Mailing Address: AK vat S ( /u 59 g Z <br /> p� 2 City State Zip <br /> Property Site Address: t 1`J( j {�',I t. �CC �yC g--ki <br /> Contact's Telephone Number: (I/ — 7j(� -cj 3 [OC k) eL. 4 <br /> Contact's Email: 50QY'&1 Gr0-- Z`� �� CQr Y1(<%-{ (l e + <br /> ° <br /> Legal Description of Property: LUT 'S A 1 li I Vuv Lu\ Z- �)L-c 3� Tr-\y O t��l l (�_ o Q <br /> Section#: Town#: N Range#: W Town of: t� ( C{v1 <br /> c <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: V1'1 f <br /> Anticipated Start Date: (0YI III e(A!t rL (Home/Cabin:Commercial Business:Bedroom:Deck:etc.) C7 <br /> � 1 �,,,I� y� <br /> Building Contractor: �a?5 ��1(;l1✓� Sewer Installer: {�, akid.e� <br /> AREA BELOR'THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISS+TED BELOW: <br /> y (p /dwt 59vcl�a`' SySTr-f'�'1 �pa�►roow�, `t,vli eac�t l�Jgl�l�Taf�/e �� <br /> S��NC�TUPe- mvi � ar� <br /> P <br /> 0 e is dcv eil/)14 /S TAG D A'H U/n/ s u C174W ors 7�le Gb <br /> SaWe- T�n� ^SKI <br /> �aS tcGq 11 y /Y� ' Fee Rec: *6y� <br /> a Check#: <br /> Date of staff site visit: / l Initials ofsite visit staff: <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: <br /> 0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> ca <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT °` c <br /> / CD i+' <br /> Transcendent: - M cm <br /> Page 1 of 4 T m g r%30 o <br /> Laserfische: - Burnett County,WI Land Use Application —Rev 1/2019 e Q <br /> m � <br /> O W <br />