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LAND USE PERMIT APPLICATION— Burnett County, WICIO <br /> r <br /> Applicant Complete All Sections Below This Line I o <br /> Permit Types and Fees:(Please,check appropriate boxes) „ <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 'il <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200j O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 c <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- .p <br /> o <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> m <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r" <br /> o <br /> Property Owner's Name: PC b E!!'" S ctnCA 2r <br /> Property Owner's Mailing Address: 0 3.2 7 7 C OJ 11 T J�d <br /> City State Zip <br /> Property Site Address:lq77 C-c���y C� L� ,-z,. �s h�r� ,� ►', /;� C <br /> Contact's Telephone Number: 7 15) `-4 S 1 <br /> � o <br /> Contact's Email: PAP &awd -,-$i ON (,-m;,;1 , L0 -1 p <br /> Legal Description of Property:N 1/1 S L S l C X C.J (& V 1 I P D S <br /> Section 4:--a-q_Town#: j a N Range#: 1 `.� W Town of: W )o cs <br /> *Attach additional a e i needed or lengthy description OR attach a co o the deed OR attach tar property p g P g f f g Y P PY f systempage. <br /> r <br /> Tax ID#(1-5 digit number; found on tax statement): 5 <br /> Proposed Use of Structure/Addition: C) <br /> Anticipated Start Date: ► - f p (Home/Cabin;Commercial Business;Bedroom;Deck;etc) ° C7 <br /> Building Contractor:_AC,-Jable- Ho,-WO ewer Instal ler: (I)a Rosr,(v1.1t <br /> AREA BELOW THIS LIME FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY C <br /> THIS PERMIT IS SUBJECT TO ALL C��// <br /> ONDITIONS LISTED BELOW: <br /> o J QaK d OW e\ 0/ H hatc t e tv ;t'1 o C/aYS 0� <br /> Fee Rec: <br /> Check#: jL I':Y <br /> Date of staff site visit- In' ' s f ite visit staff: <br /> z <br /> APPROVED BY LAND SERVICES OFF DATE: b <br /> UPON APPROVAL: APPLICANT MUST POST COPY OFCD <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ro <br /> C� <br /> CO N <br /> Transcendent: - mo g <br /> Page 1 of 4 �_ C, <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 <br />