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ro <br /> LAND USE PERMIT APPLICATION —Burnett County, WI r <br /> � b <br /> Applicant Complete All Sections Below This Line <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) <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 I C) <br /> Bunkhouse $250 ° <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(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 notlisted above will be treated as accessory structures,such as:pergolas,landscaping,etc. r. CD <br /> z <br /> Property Owner's Name: cw- ° <br /> Property Owner's Mailing Address:_1 767 0 d.1 r Gej�A�ey g <br /> City State Zip <br /> Property Site Address: S yh,e— <br /> o <br /> Contact's Telephone Number: Cp f $ a <br /> Contact's Email: c�(,-A�y{'3A,4 dG.t�w 1q<10 Ae9-lifed <br /> Legal Description of Property: o <br /> Section#: Town#: N Range#: W Town of: <br /> 0 <br /> *Attach additionalpage if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> o' <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: /0 "/)l &1 (Home/Cabin;Commercial Business;Bedroom;Deck:etc) CJ <br /> Building Contractor: -a, ,r`G-r- S4Ga> Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY DO <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z <br /> s <br /> Fee Rec: <br /> / y Check <br /> Date of staff site visit: Ini ' of site visit staff- <br /> APPROVED BY LAND SERVICES OF �( � <br /> C� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF ° <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> Ci o <br /> 1 <br /> Transcendent: - Page 1 of 4 <br /> Laserfische: - Burnett County,WI Land Use Application —Rev 1/2019 <br /> U <br />