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' LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0' c <br /> Permit Types and Fees:(Please,check appropriate boxes) _d <br /> C\ <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.) $150 Addition/Alteration to Accessory Structure $150 <br /> AccessoryStructure Commercial Industrial( / ) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> < n r <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 Boathouse $500 <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit 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. ro <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r <br /> o <br /> z <br /> Property Owner's Name:�Rz mLL�j LLye 'f'.r-- <br /> Property Owner's Mailing Address: �-j +4% IA4 <br /> City State Zip <br /> Property Site Address: Z(e Z F51-+ Ate_ (.0 k,45- R) 5 PoOn.(�A_ 1,U5' 57 4bo <br /> Contact's Telephone Number: 71 3 4`3 6-( 15 Lb o <br /> d <br /> Contact's Email: �wt� czt p cc�e- _ h e 1- <br /> Legal Description of Property: 01 U 7-4 -2 -39 (If N u11� <br /> Section#: j 4 Town#: 3`j N Range#: j!j _W Town of: �-LtS k <br /> d <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): (Scl 57 <br /> Proposed Use of Structure/Aliditiop: Gp.i(j10,d\��,..k,. S9A %,ty,.�.1, (,Z� >��.3 w <br /> ( ! x <br /> Anticipated Start Date: LC (� ( ome/Cabin;Commercial Bus ess;Bedroom;Deck;etc.) b <br /> Building Contractor: L,4fi.5v N (.,nn5-rJLta.crtbh Sewer Installer: M4,k, E%, e,%va<j <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY JI <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ^ U' <br /> x � <br /> � Fee Rec:: = <br /> ���� � Check <br /> Date of staff site visi . 7 ZXO—���T <br /> als of site visit staff: <br /> ©r0 z <br /> APPROVED BY LAND SERVICES OFFI IE� !�v � <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF OR. <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> °z <br /> vo w o <br /> Transcendent: - Page 1 of 4 <br /> CD C <br /> -03 <br /> Laserfische: - Burnett County, WI Land Use Application — Rev 1/2019 3 <br /> d <br /> a <br /> b <br />