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c .A <br /> LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Applicant Complete All Sections Below This Line c <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> A Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 CO <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 /> o ^ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 r .Z <br /> Filling/Grading $150 Boathouse $500 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 C' <br /> w <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 /> CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r. <br /> o <br /> j! <br /> Property Owner's Name: V I E,Uv I ti 6 S -9 9A K #4J P l <br /> r <br /> 11 I� o <br /> Property Owner's Mailing Address: L0 g ���'tS Ct.K-(- 1 e,W l/. AA tj $SI I � $ 7 <br /> City State Zip <br /> Property Site Address: <br /> C � <br /> Contact's Telephone Number: <br /> d <br /> Contact's Email: V IC-h)v' ✓Sl A4 K <br /> QEsc 0379113 <br /> Legal Description of Property: S 1h- N W A/ft) L Y(0 1/U 0 C / F i E x ,_) <br /> Section#: Oct Town#: 0 N Range#:--RP W Town of: V4,e 4.l4ivd <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 /> o' <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: 14z,► F- x <br /> Anticipated Start Date: {Q S,4,e (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ° rj <br /> Building Contractor: Sewer Installer: 9u F S Iw/rK � <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY c1.1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: s� <br /> btsPtcf�r �ar awter ba �olivt� �e( uirL►Mew�S. z <br /> x <br /> Fee Rec:3 'Co <br /> Check#: <br /> p <br /> Date of staff site visit: 9 �a q Initials of site visit staff: D <br /> APPROVED BY LAND SERVICES OFFICIAI,x(�+ TE: 1 �� a 0 r <br /> ( w <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF C co <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT COD ^� <br /> 00 <br /> CD c <br /> Transcendent: Page 1 of 4 w tv <br /> -3 <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 <br />