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LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> Applicant Complete All Sections Below This Line C, o <br /> �A a <br /> Permit Types and Fees:(Please,check appropriate boxes) d <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(, a tc.) $150 Addition/Alteration to Accessory Structure $150 �� R <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 0 <br /> Filling/Grading $150 Boathouse $500 ° �11 <br /> Six Month Camping Unit(One Per Year) $100 1 Permit Extension(1 Year Extension-Allowed Once) $100 U <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 /> Property Owner's Name-P 11L t CN(t Z. L 0 j jU P, o ° <br /> Property hOwner's Mailing Address: -�[��l al �'1 CJ �"•n+V'«1 to J Y <br /> State ZCit <br /> Property Site Address:' D 543b <br /> a <br /> Contact's Telephone Number: 3 ),rbQ © a <br /> Contact's Email: cQ / s�fi�� � tMt <br /> Legal Description of Property:�G��ri-,en S (-c, <br /> Section#: 3 Cj Town#: N Range#: jLl so W Town of: 2ki . o <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 statement):a(e3 <br /> Proposed Use of Structure/ d ition: _C C-cq - rP , <br /> Anticipated Start Date: I I _ 11'-Q (Home/Cabin;Commercial Business;Bedroom;Deck;etc) R Cj <br /> Building Contractor: DKL _p j UC rS Sewer Installer: 0 <br /> N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: L ` <br /> z " v <br /> ba <br /> Fee Rec: <br /> ` Check#: <br /> Date of staff site visit: Initials of site visit staff: v <br /> z <br /> I <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 4 Q <br /> > c 00 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> N0 <br /> Transcendent: - Page 1 of 4 ', � ra a <br /> ca <br /> Laserfische: - Burnett County,WI Land Use Application-Rev 1/2019 FED <br />