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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> En <br /> Applicant Complete All Sections Below This Line c <br /> a <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 -00 <br /> mow <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 �\CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 �Q <br /> o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 � <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r- <br /> r— <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) 1$100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> m <br /> 0 <br /> *NOTE:After-the-fact permits(permit aqui red 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 /> 0 <br /> Property Owner's Name: �`�( � 2 t� �-� . l t1 h�f �/� ° <br /> Property Owner's Mailing Address: J*zr k—>ne Is M A.) 65-4110 <br /> I / �J city State Zip <br /> Property Site Address: 10(w-0 A le / �t -0 b►' (V S"$3 L <br /> Contact's Telephone Number: l<l - 3 S 3 c <br /> Contact's Email: 1 I to a'( l .G6y'* <br /> N- 01- PIA=S Lv4 it a-Pk-T Vac i'Vollie Pine) ,Dr <br /> Legal Description of Property: 1) it 6 5 let W Town of: 4j� 5 � ke 3 + pC L IN-5 a 4q-7 W � ao <br /> Section#: 14 Town#:��N Range#:_If j� d <br /> *A ttach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> o' <br /> Tax ID#(1-5 digit number;found on tax statement): 34)77 0 <br /> Proposed Use of Structure/Addition: 60 18�e— x <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc) C7 <br /> Building Contractor: rtt 2ya 1Vu-(4-- Sewer Installer: � <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z <br /> ti Fee Rec: <br /> x <br /> ? Check#: I G!' <br /> Date of staff site visit Initi is of site visit staff: r <br /> APPROVED BY LAND SERVICES OFFICIAA� <br /> r- <br /> a � <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 0 W c <br /> A m <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ` 6tJluu <br /> ao 0 <br /> c9 N <br /> Transcendent: - Page 1 of 4 113ca <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 1/2019 M <br />