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E <br /> LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> Applicant Complete All Sections Below This Line " �o <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure 4 $30b Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure 300 Addition/Alteration to Commercial/Industrial Structure $200 <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 /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 r- <br /> 0 <br /> Filling/Grading $150 Boathouse $500 r(� <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. c- <br /> o r. <br /> Property Owner's Name: <br /> °o Z <br /> Property Owner's Mailing Address: y vJ S o <br /> City State Zip n„ <br /> Property Site Address: � 1 1,� L� ij��a� ��;r j ��/iJy 1-� Jkyy � <br /> o <br /> Contact's Telephone Number: Ji3 /7/5-'v2 U <br /> d <br /> Contact's Email: <br /> Legal Description of Property: z-.o,/- / 7q{�Q �r� fc� c <br /> Section#: e5,7 Town#: IS- N Range#:--1-5--W Town of: 0 <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page.* �" <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: &/h e <br /> x <br /> Anticipated Start Date: �� �� (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C7 <br /> Building Contractor: U l /J�"�t✓ C��aj��' � Sewer Installer: �l�1��:••y � <br /> b <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: G <br /> (NAV&?e), py-ple.5e'd lDc4 <br /> d Love, / 4i is el e Vq�r d I r6 <br /> 1us� A*CgAo� r�►� 0�5�,�`� V/S17Lorl 8/Z309 <br /> /YD 1ve Fee Rec: C <br /> ^ / _ -/ x <br /> <Q� �C',y✓10 fl GFL y Check#: <br /> a y 8' z3 � � 3,R <br /> Date of staff site visit: J Initials of site visit staff: / r r <br /> o <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: g� l <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF C3 e- <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a a <br /> n <br /> Transcendent: - Page 1 of 4 c <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 <br /> o <br /> b <br />