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LAND USE PERMIT APPLICATION — Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure <br />$300 <br />Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure <br />$300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory structure (Garage, Shed, etc.) <br />$150 <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) <br />$200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Driveways/ & Campground Structures <br />$125 <br />Bunkhouse <br />$250 <br />WI State Statute 59.692(iv) Structures <br />$350 <br />Filling/Grading <br />$150 <br />Boathouse <br />1$100 <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />Permit Extension (1 Year Extension - Allowed Once) <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, landscapinq, etc. <br />Property Owner's Name 'K L i f-J fro Ift r <br />Property Owner's Mailing Address:) 1 (I ? '70, 6216 -1-q ; <br />Property Site Address: 6,5'',30 6 r, W --)J I IF City State Zip <br />Contact's Telephone Number:k S / — Z 3 & -- 9 72 0 <br />Contact's Email: A/e.14, l� <br />Legal Description of Property: <br />Section #: 35 Town #:_N Range #: W Town of: %� �`� VA 0 /J <br />*Attach additionalpage if neededfor lengthy description OR attach a copy of the deed OR attach tae system property page. <br />Tax ID # ( 1 -5 digit number; found on tax statement): <br />Proposed Use of Structure/Addition: (yOa,v 6- " <br />Anticipated Start Date:__&,-tr A f.( S -g rfHome'Cabin: Commercial Business: Bedroom .) : Deck: etc <br />Building Contractor: 0WfX�e k- / Sewer Installer: A11=4 <br />AREA BELONV THIS LINE FOR LAND SERVICES STAFF COMINIENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />B ' <br />ve c �oh�ccr-E=i <br />'S-�`(.k-c-t Lv''e Wa,S to correct. .ek2VQ,% <br />lam. <br />Date of staff site visit: KInitials of site visit staff: <br />APPROVED BY LAND SERVICES OFFI <br />TE: )C-1.1 i <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: - <br />Page 1 of 4 <br />Laserfische: - Burnett County, WI Land Use Application — Rev 1/2019 <br />N <br />0 <br />�ro <br />c <br />05 <br />z <br />z <br />Rec: l 00 <br />:k#: <br />r <br />C <br />a <br />m <br />W <br />N <br />CIO <br />o <br />CD = <br />p, `S <br />IV <br />O <br />to <br />CD <br />