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LAND USE PERMIT APPLICATION-Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line ' <br /> C <br /> z ` <br /> Permit Types and Fees:(Please,check appropriate boxes) \ d W <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 p(� <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 -`t <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> AccessoryStructure Commercial Industrial <br /> ) $200 CD <br /> .AAdition/Alteration to Bunkhouse $150 <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 $500 ° �Ql t <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. ro <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> R� m� � 9 <br /> Property Owner's Name: 'S M NR ' T-5 1C(&E �}l/1(Ltl L ° <br /> Property Owner's Mailing Address: Wz <br /> City State Zip (— <br /> .—U <br /> Property Site Address: SWE <br /> Contact's Telephone Number: 71 5 (a 5S 2 O9 a� <br /> Contact's Email: Ora ftSphOf"ma,l !.COm <br /> Legal Description of Property: 06 k Zq ke— 1W NO • J LC74 <br /> Section#: Town#: N Range#:--[�—W Town of: <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): I q l ( O <br /> Proposed Use of Structure/Addition: 6 ANb R OMKHO05C o k <br /> Anticipated Start Date: JEPT- I -ZQ/4 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C7 <br /> Building Contractor: JE FF P1 ER.CE Sewer Installer: ff6PK/N S ti <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THUS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> tAt4 �tAA:, tA1rre vie �s� See BOG t <br /> y Fee Rec: ,20,0? <br /> x <br /> Check#: <br /> 14 <br /> 7 M <br /> Date of staff site visit: � Initials of site visit staff: J M <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF y <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> � r <br /> z 0 3 <br /> A <br /> Transcendent: - y ^' <br /> - Page 1 of 4 00 C <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 1/2019 -0� CDCn <br /> m <br /> a <br />