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CD <br /> LAND USE PERMIT APPLICATION — Burnett County, WI <br /> N <br /> Applicant Complete All Sections Below This LineCD <br /> o <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> c — O <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br /> 'z <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 Tj <br /> X Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 r <br /> filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 m <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. E — <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 /> 0 <br /> Property Owner's Name: 904;' I:b- TIER N IJ)-tE ri )CC- ° <br /> Property Owner's Mailing Address: 3tlZ 1n4 98'7� l)j 4 Tz13 H K , q 31 $ <br /> City State <br /> Property Site Address:,� 2 Lw 1'0c ��}J�,j3 u p y Wt 54 <br /> C <br /> Contact's Telephone Number: q 5 a ,S 6 3 o a <br /> y� V d <br /> Contact's Email: �D t�1,D 31_�}14 LW <br /> Legal Description of Property: <br /> Section#: Town#: N Range#: W Town of: <br /> d <br /> *Attach additional page if neededfor 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 /> Proposed Use of Structure/Additi n: �XPAIJn>^ 17�cK o w <br /> � x <br /> Anticipated Start Date: Ipl/s 19 (Home/Cabin;Commercial Business;Bedroom:Deck;etc) ° p <br /> Building Contractor: Sewer Installer: <br /> AREA BELO`N'THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z d <br /> z <br /> Fee Rec: n? <br /> I Check#: q � <br /> Date of staff site visit: I l Initbrh of site visit staff: rn <br /> a <br /> ? z <br /> APPROVED BY LAND SERVICES OFFICI E: JO <br /> a <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT = <co r <br /> r <br /> Transcendent: - o � <br /> o o <br /> Page 1 of 4 ,, V 0 ry <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 rn wq <br /> m � <br /> O A <br />