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LAND USE PERMIT APPLICATION — Burnett County, WI b r <br /> CD <br /> G r <br /> < V <br /> Applicant Complete All Sections Below This Line <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) O Cry <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 /> 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(1v)Structures $350 C. <br /> 0 <br /> Filling/Grading $150 1 lBoathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 1 113ermit 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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> c <br /> �\ o <br /> Property Owner's Name: �c�.�Lra ��S <br /> g FA 2 r't L-A p` <br /> PropertyOwner's Mailing Address: vZ `l J c„tw i _ <br /> Cit State Zi <br /> jp (V <br /> Property Site Address: 7 J 1 r�s �' Ci ✓ W/121 S(l(7 C W <br /> Contact's Telephone Number: 803 b a <br /> Contact's Email: 7p,a C-(-- Cep c� Q— nC.7 o--,, ��j s✓d 3-111 <br /> Legal Description of Property: M g y Z-Yy i b yley /o 0 00 <br /> Section#: �S Town#: N Range#:� W Town of: QCi/�lE�� <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): <br /> o <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: f P (Home/Cabin;Commercial Business;Bedroom;Deck;etc) � p <br /> Building Contractor: Jo{ 9-lwd ��hf��' � J14Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: G <br /> z <br /> Fee Re3�.®� <br /> T <br /> Check#: <br /> Date of staff site visit: 1� �, 6 \ nitials of site visit staff: ' y <br /> ° <br /> APPROVED BY LAND SERVICES OFF 10-13�O <br /> � a O <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> 2.3 <br /> o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 00 <br /> 0 00 r^� <br /> 00 <br /> r, v C N <br /> C� <br /> Transcendent: - Page 1 of 4 c' <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 <br /> ° <br /> a <br /> b <br />