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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> < b <br /> Applicant Complete All Sections Below This Line `D <br /> a <br /> .17 <br /> d <br /> Permit Types and Fees:(Please,check appropriate boxes) W ^� <br /> Dwelling/Principal Structure $3001 Addition/Alteration to Dwelling/Principal Structure $200 " n <br /> Commercial/Industrial Structure $3001 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 of <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(iv)Structures $350 0 <br /> Fillin /Grading $150 Boathouse $500 <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 /> Property Owner's Name: Dan Q r y j3o,,- Q ° <br /> -n <br /> /� �/ o <br /> Property Owner's Mailing Address:Yyy5 Gt'e-e1`IAct✓en Dr, V"015 h`ei o 1h S S I)7 -1 <br /> ry� / ! City State Zip <br /> Property Site Address: a 7 ygY R �Z , 1 C/ W�f�S f E'! <br /> C <br /> p 651 398- 6 &ZIJ <br /> Contact's Telephone Number: <br /> d <br /> m <br /> Contact's Email: LL J <br /> Legal Description of Property: b er 1(,x.t 16 ec K r5"U 4-f Devi 5 �a k, 4 t 11( <br /> Section#: _Town#: _N Range#:16W Town of: Oal Qi2d "°° <br /> t7 <br /> *Attach additional page if needed for lengthy description OR attacth,+a copy of the deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number;found on tax statement): IV <br /> Proposed Use of Structu--'Addition: Q ro q e— ° <br /> Anticipated Start Date:�'i''�{� /9 (Home/Cabin;Commercial Business;Bedroom;Deck;etc) C7 <br /> Building Contractor: Xre J Q ie r Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDTTIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> t l s <br /> Na-�-- �c- b1,v�.wec�r.. �b�-��►a� z <br /> i \ � <br /> 0\/2 Cj� -�2 ,S ��7L �aCKA 1 e W1ec� <br /> qq ,�� l�r>w,Qr �� � <br /> rs alr0.S e 1� - 12I Y Fee Rec:� <br /> Check#: <br /> 1 a <br /> Date of staff site visit: nitials of site visit staff: <br /> APPROVED BY LAND SERVICES OF CIAL: DATE: 9 a a w <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF C a) M <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o w <br /> © Q <br /> •t m C tV <br /> Transcendent: - Page 1 of 4 `� <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 <br />