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LAND USE PERMIT APPLICATION — Burnett County, WI Cr <br /> C r <br /> a <br /> Applicant Complete All Sections Below This Line 0 <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 O <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 <br /> o <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 <br /> r <br /> Filling/Grading $150 Boathouse $500 <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> $ <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. r. <br /> 0 <br /> z <br /> Property Owner's Name: e V- &A-7 A �4' loo t,✓ <br /> Property Owner's Mailing Address: . S` 2 2Z -- J 7 K-t S4.z S o <br /> City State Zip <br /> Property Site Address:-9(,,q Z b p,L; e-4- '7c,> <br /> Contact's Telephone Number: -7 I S - Z 4,5—yy 2 <br /> C <br /> d <br /> Contact's Email: <br /> Legal Description of Property: o <br /> Section#: S Z t Town#:_:I 38 x.N Range#: O t W Town of: b 4 4jr&L s a <br /> r7 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page. <br /> o' <br /> Tax ID#(1-5 digit number; found on tax statement): 2--4 <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: (Home/Cabin;Commercial Business,,Bedroom;Deck;etc.) O <br /> Building Contractor: Z i r-,,, Nit=Yt;A— Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TP ALL CONDITIONS LISTED BELOW: rb <br /> z <br /> z Fee Rec: <br /> Check#: � <br /> Date of staff site visit: 7 C� Initials of site visit staff: v a Q <br /> z r�� <br /> may-! c r <br /> APPROVED BY LAND SERVICES OFFI I DATE: <br /> n m W V <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF m <br /> 00 <br /> ''y W C NJL-7 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o m n Q' <br /> Transcendent: m <br /> Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2019 <br /> 0 <br /> a <br />