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LAND USE PERMIT APPLICATION - Burnett County, WI r <br /> a 3 <br /> Applicant Complete All Sections Below This Line s <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300rAddition/Alteration <br /> dition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300dition/Alteration to Commercial/Industrial Structure $200 O <br /> E <br /> Accessory Structure(Garage,Shed,etc.) $150dition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 to Bunkhouse $150 C� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk nkhouse $250 ° <br /> Driveways/&Campground Structures $125 State Statute 59.692(ly)Structures $350 r- <br /> Filling/Grading $150 lBoathouse $500 o <br /> Six Month Camping Unit(One Per Year) $100 1 jPermit Extension(lYear 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. r <br /> o <br /> n z <br /> Property Owner's Name: G G-- PIP^ ° <br /> Property Owner's Mailing Address: q,53 C C A), /Qtt Q l <br /> r _ City State Zip55J 1 s- r <br /> Property Site Address or�S��O <br /> o <br /> Contact's Telephone Number: <br /> 1 <br /> Contact's Email: „ J1 .t <br /> 1 <br /> Legal Description of Property: CAM 1 rl ov LO t- o <br /> Section#: Town#: N Range#: W Town of. UP <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: <br /> Anticipated Start Date: (Hom i ;Commercial Bu`ness;Bedroom;Deck;etc.) � p <br /> Building Contractor: ��y� �p j-;f'Z�J j7 Sewer Installer: to <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF CONINIENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: G <br /> z G <br /> Fee Rec: <br /> co <br /> Check#: a.0,.3 <br /> �( o <br /> Date of staff site visit: r� ` Initials of site visit staff:���-� a <br /> z <br /> C <br /> APPROVED BY LAND SERVICES FI AL: V(Z)���­DATE: o- < F" ��= <br /> 11 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Transcendent: - <br /> Page 1 of 4 <br /> m <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 r-- —� <br />