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C � l <br /> LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Please,check appropriate boxes) °= <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $15o 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) 15100 Permit Extension(1Year Extension Allowed Once) $100 <br /> PS <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. b <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r <br /> z <br /> Property Owner's Name: ..�5 �,�! (�Q.JG�/� (1G/�O/�i� �, V�l <br /> Property Owner's Mailing Address: �S �'�� "�S ' ? <br /> _ ?✓� Cit �te Zip <br /> Property Site Address: t <br /> o c <br /> Contact's Telephone Number: 3 � - 3 -/X S C), _ <br /> e 6, <br /> Contact's Email:/1eq.-xL-- /1�0�i�r!��r/��/'��� �Ca/✓I <br /> Legal Description of Property�f�TTi�, /��i�/ ✓�yl �/� Lei/11466 ZIP/ —3121 Q <br /> � � W <br /> Section#:/_Town#: N Range#:�``— W Town of: /�.�C.' d <br /> *Attach additionalpage if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: O 5 <br /> Anticipated Start Date: f (Home/Cabin;Commercial Business;Bedroom;Deck;;etc) <br /> Building Contractor AQ,/ -S Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z <br /> L� <br /> y Fee Rec: <br /> x <br /> Check#: cl"- `-' <br /> Date of staff site visit: Initials of site visit staff: > <br /> z <br /> 0 <br /> APPROVED BY LAND SERVICES OFFIC AL: TE: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF r- <br /> 03 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 9 :2Cn <br /> 3 `T' <br /> -v <br /> CD <br /> o <br /> Transcendent: - Page 1 of 4 90 o c n <br /> n <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 Q <br /> d � caD <br />