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ro <br /> LAND USE PERMIT APPLICATION — Burnett County, WI C <br /> Applicant Complete All Sections Below This Line <br /> a. <br /> Permit Types and Fees:(Please,check appropriate boxes) m <br /> Dwelling/Principal Structure $300 Idn <br /> /Alteration to Dwelling/Principal Structure $200 ' <br /> Commercial/Industrial Structure $300 /Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 /Alteration to Accessory Structure $150 CD <br /> Accessory Structure(Commercial/Industrial) $200 /Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk se $250 <br /> o <br /> Driveways/&Campground Structures $125 Statute 59.692(ly)Structures $350 <br /> r <br /> FiIIin Gradin °g/ g $150 se $500 <br /> Six Month Camping Unit(One Per Year) $100 tension(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. ro <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> � <br /> Property Owner's Name: �--- C� � r� I? _l ,� o <br /> CProperty Owner's Mailing Address-_ 3 / , ' A j ity St t Zip � <br /> Property Site Address: !l C/dl `' L-1V /'V4 ftf <br /> Contact's Telephone Number: —/� � 7 �3 0 <br /> Contact's Email: <br /> v r ✓ 7� <br /> Legal Description of Property: o N <br /> Section#: _Town#: LIDN Range#: W Town of: D <br /> d <br /> *Attach additional page if needed for 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 st/aterAent): <br /> Proposed Use of Structure/Addition:/-fG�{-Cl+r W7 I'D C4hl n v) k <br /> Anticipated Start Date: I7la ;Z-b d (Home/Cabin;Commercial Business;Bedroom;Deck:etc) o d <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> kc) 2d <br /> x Fee Rec: J.2)C)!a <br /> /ry / q Check#: <br /> Date of staff site visit: v 17 d ! Initi s f sitc visit staff: r <br /> a <br /> z <br /> APPROVED BY LAND SERVICES OFFICI <br /> UPON APPROVAL: APPLICANT MUST POST COPY OFCD 00 y Q _ <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> r 0 ,0 nD <br /> Transcendent: - Page I of 4 �_ r*�2 o <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 3` cc C4 <br /> o tD �U <br /> 'V <br />