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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> b <br /> Applicant Complete All Sections Below This Line <br /> a i <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 Bunkhouse $250 o z\ C6 <br /> Driveways/&Campground Structures $125 Wl State Statute 54.642(1v)Structures $350 t- <br /> 0 <br /> Fillip /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 not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r- . <br /> 0 <br /> Property Owner's Name: 10 <br /> Property Owner's ailing Address:X V U S��� ��"®� `�` }� S % 1 <br /> Q �� _ City State Zip <br /> Property�itte Address; � ��•Cc+v�.j /� /� �v-�✓S/� v,,�- S� �� 4 <br /> < <br /> Contact's Telephone Number: <br /> _ d <br /> Contact's Email: j q/'0(-0 1-fu7/ /",4; 1 �� <br /> Legal Description of Property: a 01 g J j ' �C y�l l ' o a4 <br /> a <br /> Section#: O Town#:39 N Range#: A W Town of: 1q) CZA0 r1 UQ <br /> d <br /> *Attach additional page if needed far 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): Q z„ <br /> Proposed Use of Structure/Addition: �d�rLr� 7�7 <br /> Anticipated Start Date: l�� (Hone/Cabin;Commercial Business;Bedroom;Deck;etc) ° G <br /> Building Contractor: /46 G Sewer Installer: H <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY G <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z <br /> r� <br /> Fee Rec:,:�W <br /> Check#: (LQ <br /> 8 <br /> Date of staff site visit: Ini ial f site visit staff: r <br /> APPROVED BY LAND SERVICES OFFICI <br /> DXW�, � <br /> CA <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT y <br /> Transcendent: - M Cv e a <br /> Page I of 4 _ c <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 `, <br /> ff <br /> 7 u"u <br /> H <br /> ro <br />