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LAND USE PERMIT APPLICATION - Burnett County, WIr CD <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 $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 -p <br /> f <br /> 4 Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 .� Q <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 r <br /> 0 <br /> Filling/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. ro <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r. R 4-7-. <br /> Property Owner's Name: O n I��1`�Q o z <br /> 0 <br /> m <br /> Property Owner's Mailing Address: ) G1 S Sfi, M. 3 S W eb Skec W � S TVY� <br /> a1 �, ZI <br /> City State Zip <br /> Property Site Address: I <br /> O ti <br /> Contact's Telephone Number: 1 s ' S(z b' a S 6 <br /> Contact's Email: G4'-k QN-NA MgA .Cow\ � <br /> v <br /> Legal Description of Property: \ <br /> Section#: a� Town#A0 N Range#: 110 W Town of: oak 1QV0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: s�o t,,�g <br /> Anticipated Start Date:_ Q .C (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ' C7 <br /> Building Contractor: Sewer Installer: 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF CONIiyIENTS/CONDITIONS ONLY U` <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> • L©ca:��o n a ccond l)! z �o <br /> 1-o o^erAll <br /> .� Fee Rec:��'" <br /> 1 y Check#: ql]0 <br /> o <br /> Date of staff site visit: I 'tials of site visit staff: <br /> z <br /> C <br /> APPROVED BY LAND SERVICES OFFIC ATE <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 = - <br /> z a -. , <br /> N <br /> N <br /> Transcendent: - Page 1 of 4 F v 0 Cn <br /> ^' <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 3 <br /> m � <br /> o <br /> D <br />