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LAND USE PERMIT APPLICATION - Burnett County, WI <br /> Applicant Complete All Sections Below This Line <br /> a W <br /> Permit Types and Fees:(Please,check appropriate boxes) Zz <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 " 'J <br /> Commercial/Industrial Structure $300 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) $2 00 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewa k 2Av Bunkhouse $250 <br /> o <br /> XDriveways/&Campground Structures�� WI State Statute 59.692(ly)Structures $350 C. <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- fired after construction has be un)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. b <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r <br /> z <br /> Property Owner's Name: R 0 bQ.-rj 6 of—Q r / Sck%--«I-, PL-11,.1,q ° <br /> -n <br /> Property Owner's Mailing Address:,3 a 9. r r S4 A1W Jn+r,'� fch,-,C t (n n sso <br /> 1 City State Zip <br /> Property Site Address: XYf X l�� } ,e q.�C� CJn_ GJ f 89-S <br /> Contact's Telephone Number: 7 6 L'f'3 9 O Q 3t 3 � C v <br /> ` -t C5 <br /> Contact's Email: rc> R)C4\ oZC�� OV, aS 3 J d <br /> Legal Description of Property: �O+3 A S Pew 0 t AP_ l.✓'n- f G,/ �j�����3� 0 <br /> Section#: Town#: N Range#: W Town of: <br /> r7 <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):3 <br /> Proposed Use of Structure/Addition: ��� c <br /> Anticipated Start Date: Q O� Jetc.) o <br /> p � ,� (Home/Cabin;Commercial Business;Bedroom;Deck; � <br /> Building Contractor: 5 e_ Sewer Installer: , `1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z �l <br /> __j Fee Rec: L!DL> <br /> / U Check#: <br /> i�! o <br /> Date of staff site visit: Initials of site visit staff: /� 111 = <br /> v'� z <br /> APPROVED BY LAND SERVICE DATE: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT -- <br /> z <br /> n w _ <br /> Transcendent: - Page 1 of 4 A p <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 <br /> o <br /> D <br /> 3 <br />