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LAND USE PERMIT APPLICATION— Burnett County, WI <br /> Applicant Complete All Sections Below This Line <br /> d <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 C) �" <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < '� <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> Filling/Grading $150 1 lBoathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 1Permit 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. CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: F/ �'; � (!1S&I �y � <br /> Property Owner's Mailing Address: C7 y1� A X41 �e� T���y:`� �• � Q <br /> _ City.. State Zip ZA <br /> Property Site Address: qo _Y, 0Q,.4 d r/r'cis i d <br /> � � C <br /> Contact's Telephone Number:�> Z y� ' y� S a <br /> �J d <br /> Contact's Email: 00 svy, 3� ` � C..I Z C-00— <br /> Legal Description of Property: +��S'� 1?* O z'a �� 5E Q,,qr" pr�'T o °° <br /> Section#: 41 Town#: _N Range#: S W Town of: <br /> d <br /> *Attach additional page if needed for lengthy description OR attach 7a copy ofthe deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number;found on tax statement): R?251 0 3a 51 <br /> /sue--� o <br /> Proposed Use of Structure/Addition: c.c !m k <br /> Anticipated Start Date: ( ome/Cabin;Commercial Business; .)Bedroom;Deck;etc C7 <br /> Building Contractor: 14e Sewer Installer. N/A <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PER T IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> (, <br /> N <br /> � <br /> e �� � C-- h�r'v`." • �0.� � Fee Rec: <br /> Check <br /> Date of staff site visit: 4 In' ' is of site visit staff: > <br /> APPROVED BY LAND SERVICES OFFICI <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> O n �n <br /> ao a <br /> Transcendent: - c <br /> Page 1 of 4 n <br /> CD <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 <br /> d <br /> y <br />