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ro <br /> LAND USE PERMIT APPLICATION—Burnett County, WI t~ <br /> Applicant Complete All Sections Below This Line <br /> o. <br /> Permit Types and Fees:(Please,check appropriate boxes) d U <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 C O <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 1 Bunkhouse $250 <br /> 0 <br /> Driveways/&Campground Structures $125 IWI 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(1Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fad 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 notlisted above will be treated as accessory structures,such as:pergolas,landscaping,etc. r. <br /> Property Owner's Name: <br /> Property Owner's Mailing Address: ( i Q Q-µ i $ l� <br /> City State Zip 5 �� <br /> Property Site Address:Qvy-,e <br /> Contact's Telephone Number: 15-'^�H —7 O'7 5' <br /> _a <br /> C7 <br /> Contact's Email: <br /> �s N <br /> Legal Description of Property: L w� <br /> Section#: a�P Town#: N Range#:__�_t�, W Town of: ft ee h, 15 <br /> K'ar0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> o' <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: �o V <br /> Anticipated Start Date:NC O\j is ,a( \T (Home/ in.-Commercial Business;Bedroom;Deck:etc) p <br /> Building Contractor: Sewer Installer: <br /> b �.. <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COINIMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Kca A�, <br /> Fee Rec: <br /> Check#: /159 <br /> e-VQ <br /> Date of staff site visit: Ini ' Is of site visit staff: a <br /> z <br /> 0 <br /> APPROVED BY LAND SERVICES OFFICI '-1 -0-16l� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> CD <br /> N = <br /> Transcendent: co <br /> - Page 1 of 4 00CD C: N o <br /> Laserfische: - Burnett County,WI Land Use Application -Rev 1/2019 �_1CD <br /> Q <br /> C <br />