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LAND USE PERMIT APPLICATION-Burnett County, WI <br /> a <br /> < - b <br /> Applicant Complete All Sections Below This Line N <br /> Permit Types and Fees:(Please,check appropriate boxes) ) <br /> Dwelling/Principal Structure f$150 <br /> Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) Addition/Alteration to Bunkhouse $150 ~ <br /> 1Deck/Stairs/Patio/Retaining Wall/SidewalkBunkhouse $250 <br /> 0riveways/&Campground Structures WI State Statute 59.692(ly)Structures $350 <br /> Filling/Grading Boathouse $500 <br /> Six Month Camping Unit(One Per Year) Permit Extension(1 Year Extension-Allowed Once) $100 <br /> 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 /> 2A 1 Cc or- <br /> ProP rty Owner's Name: 3z <br /> (� <br /> Property Owner's Mailing Address: 0`-' t( a <br /> City State Zip <br /> Property Site Address: efv Y5i 6—LOw t` m K, K <br /> Contact's Telephone Number: 6p �— 'Bo??--4 36 o <br /> 0. <br /> Contact's Email: �%G 5'i" M r�h�_�c3 I L•C.Gw1 <br /> Legal Description of Property: LbT10 CS V.1� P. 2-%,>j5c.c rt�nI�jyQK FL16W N -C <br /> Section#: Town#: N Range#:'Tg64Al6 W Town of. Q AXv_"0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page. <br /> , <br /> Tax ID#(1-5 digit number; found on tax statement): 3�3 <br /> Proposed Use of Structure/Addition: 5 i c9 ,A;A <br /> z x <br /> Anticipated Start Date: 21- 2.0[ q (Home Cabin:Commercial Business;Bedroom:Deck;etc.) � C7 <br /> Building Contractor.4f_ 1jP4 fl\ N1,j-�- ( Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENT'S/CONDITIONS ONLY' n, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: V <br /> Fee Rec:� <br /> Check#: J( C) <br /> Date of staff site visit: �C/ — Initia s of site visit staff. <br /> APPROVED BY LAND SERVICES OFFIC <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF (D M <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z o o <br /> Transcendent: <br /> Page 1 of 4 F w ` <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 < CD [jam <br /> Cyyy <br /> y i <br /> D <br /> Z <br />