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R. LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line c <br /> C <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 Q <br /> Accessory Structure(Garage,Shed,etc.) y 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 /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 r- <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> 0 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the norm�fee. <br /> rca ion Towers&Signs require a r eren app rcatron -see correspon rng app!cation,an ees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r <br /> ( 0 <br /> Property Owner's Name:1&-C If d-L14,Ja �� Vt�t�2 r ° <br /> �n <br /> 1 8 <br /> Property Owner's Mailing Address: 1� (el C vt�t� ��1-T 2l�X� ►� S C� $ <br /> City State Zip C4 <br /> Property Site Address: 5? 7fe r t 4 <br /> C y <br /> Contact's Telephone Number. <br /> Contact's Email: <br /> M ry f,G S'C� Cc un C,-,s'f, vle:t// <br /> Legal Description of Property: 1-o I S G`5 V� R. <br /> P V <br /> Section#: �Town#: N Range#: W Town of: ��c�C�7a K <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 /> n' <br /> Tax ID#(1-5 digit number; found on tax statement): 5�� i <br /> Proposed Use of Structure/Addition: 5"fD reiICTQ ��1Q4 E x <br /> Anticipated Start Date: MA (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ° C7 <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF CONIIIENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r0Q <br /> 71v Le- us u� -�or' ` U Mq h AOJI'l1q 1- o"11 <br /> Fee Rec: 45 Jt <br /> f <br /> Check#: <br /> 0 <br /> Date of staff site visit: !a L3119 Initials of site visit staff: 2"7,- <br /> > <br /> z <br /> 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: l `'"` '` �� DATE: /O 3 f a <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Transcendent: - Page 1 of 4 CD <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 <br /> o <br /> a <br />