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LAND USE PERMIT APPLICATION-Burnett County WI r <br /> Applicant Complete All Sections Below This Line a' o <br /> a � <br /> a <br /> Permit Types and Fees:(Please,d►eckopproprlate boxes) � <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> ommercial/Industrial Structure $300Addition/Alteration to Commercial/Industrial Structure $200 Q <br /> AccessoryStructure(Gara e,Shed,etc.) S150Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125WI State Statute 59.692(1v)Structures $350 <br /> Fillin Gradin $150Boathouse $500 <br /> n- <br /> Six Month Camping Unit(One PerYear) 1$1001IPermit 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. Cj <br /> j/ z <br /> Property Owner's Name: <br /> Property Owner's Mailing Address: <br /> City' <br /> Property Site Address: r(J� <br /> o y <br /> Contact's Telephone Number: <br /> � ��� �{'? / — 0 <br /> Contact's Email: /UP l kC /�art/ 1 S ri7�o��� �Q/60�4, N <br /> Legal Description of Property: <br /> Section#: Town#: (' N Range#: / ' W Town of: !�i/I'e4�77 <br /> t7 <br /> *Attach additionalpage if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* i <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: �f '1 e�-. c <br /> Anticipated Start Date: L-,-1-- 7` J S-,4 4?-0 F/(Home/Cabin;Commercial Business;Bedroom;Deck etc.) <br /> Building Contractor: L- +-+ tit Sewer Installer:_ 111 y � <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Cal <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> `Z� <br /> �. 1v4.c-l< -JqVm c'erITer/ii7a o /c'oQa z <br /> Fee Rec: /, <br /> a / Check#: �D-I <br /> Date of staff site visit: y �/ 'tiais of site visit staff: �`/ <br /> APPROVED BY LAND SERVICE DATE: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF m M <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT c 0 o <br /> Transcendent: - ' C= <br /> Page 1 of 4 �` s <br /> Laserfsche: - Burnett County,WI Land Use Application—Rev 1/2019 ; Nnl <br />