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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 /> CD <br /> Dwelling/Principal Structure d$2 <br /> Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure Addition/Alteration to Commercial/Industrial Structure $200 G O <br /> Accessory Structure(Garage,Shed,etc.) Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) Addition/Alteration to Bunkhouse $150 <br /> QYA <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 � '�Driveways/&Campground Structures WI State Statute 59.692(ly)Structures $350Filling/Grading Boathouse $500 <br /> Six Month Camping Unit(One Per Year) jPermit 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. <br /> Property Owners Name: ' I z <br /> _ 8 � <br /> Property Owner's Mailing Address: 3 �- � G.�L�'�.�'" � S i / - <br /> n City State Zip (� <br /> Property Site Address: <br /> C <br /> o <br /> Contact's Telephone Number:_ C1 a <br /> d <br /> Contact's Email: b r r,Ct i1 t;")iy tt_Z?F f ( _/I C C P e cd A <br /> Legal Description of Property: L.L� of cot by - <br /> Section#: Town#: N Range#: _W Town of- 5 c o / r On <br /> 0 <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 /> i <br /> Proposed Use of Structure/Addition:, 1�('1 f ��o o A- L-Ll z)ci <br /> Anticipated Start Date: (HomelCabin;Commercial Business; edroom;Deck;etc) C7 <br /> Building Contractor: se / I Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> e �j�:l a� a. e f e vl�a►.� �� i S <br /> r act* <br /> CG�. 1 e-�� -+o <br /> e14, vtonS Pe r s,g�ec� G� reelv`el�"t', <br /> Fee Rec: of�d zo <br /> /I Check#:-Ti <br /> � 14 <br /> L.� <br /> Date of staff site visit: 17-�"j�I1 Initials of site visit staff: a <br /> d <br /> APPROVED BY LAND SERVICES OFFICIAL: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF y W M <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT µ <br /> z ;o <br /> Transcendent: - Page 1 of 4 tv <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 1/2019 3 <br /> d <br /> b <br />