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CA <br /> LAND USE PERMIT APPLICATION —Burnett County, WI <br /> a _ � <br /> Applicant Complete All Sections Below This LineCD <br /> o <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure 1$3001 lAddition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> F <br /> cC�essory Structur (Garage,Shed,etc.) 50 Addition/Alteration to Accessory Structure $150 <br /> CD <br /> Accessory Structure(Commercial/Industria Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> Driveways/s/&Campground Structures Y pg $125 WI State Statute 59.692(1v)Structures $350 <br /> 1711 <br /> Filling/Grading $150 Boathouse $S00 ° <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> m <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. CD <br /> ro <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc, r., <br /> f�Q I fi ( 2a�e 1 �► ld�rl �� z <br /> Property Owner's Name: I— <br /> Property Owner's Mailing Address: 19-171 Al 6,rbr�e $'a 41 L-e-r; �.�Z SYeS 3 <br /> // City State Zip rr„ <br /> Property Site Address: �' r 1 y d V e, <br /> Contact's Telephone Number: bar '7 0 6 I`ro rY,e 7rs'— a <br /> 0 <br /> v <br /> Contact's Email: <br /> Legal Description of Property: S £ v <br /> Section#: _Town#:—_3 7 _N Range#:—__L8 W Town of. TI-ade [a k e- <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 /> Proposed Use of Structure/Addition: Get-e*As e, o x <br /> Anticipated Start Date:_0c tO b tr Hfh a1 O( l (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) p <br /> Building Contractor: O wAt r Sewer Installer: ©w n e r (� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CO'rDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> � z <br /> Fee Rec: <br /> r N Checkn#:� <br /> v�[} m <br /> Date of staff site visit: � v' ` � Initials of site visit staff: <br /> APPROVED BY LAND SERVICES OFFICIA��. <br /> 0 <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 w <br /> a <br />