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LAND USE PERMIT APPLICATION- Burnett County, WI r <br /> a r <br /> b <br /> Applicant Complete All Sections Below This Line �' c <br /> 0. <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 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 <br /> r <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 w <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. r <br /> p j L � z <br /> Property Owner's Name: /l t ,c R A_l � �' ��/� e. la- ��/Z h L/2 CZ rn <br /> Property Owner's Mailing Address: l S 3 4'. f' <br /> City State Zip U <br /> Property Site Address: ( S C- 2/Z fS b t c t-- W...L U <br /> / // o <br /> Contact's Telephone Number: crz �-2 " -Z � � ' �-a 9 U !" 7/s- `J_Z P 411 <br /> �D) <br /> Contact's Email: / -E,4 <br /> Legal Description of Property: 1V J f A S/4 0 re- -2 s, /cz rz V/ I', L6-�-4 0 � <br /> Section#: Town# � Range#:�_W Town of: V o o 4 /P I y C_r" <br /> C7 <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):—. 9S^y9 ' <br /> Proposed Use of Structur ddition: 5 C ree q /`"6 r C o <br /> F <br /> Anticipated Start Date: i L q (HomeiCabin;Commercial Business;Bedroom;/der •etc.) ° p <br /> Building Contractor: r'( ' /�A1�13Y Iint. . JI Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: CT� <br /> Fee Rec: <br /> Check#: <br /> / T <br /> Date of staff site visit: [O Ini ' s of site visit staff: <br /> > <br /> z � <br /> APPROVED BY LAND SERVICES OFFICIAL: <br /> w <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> � Q <br /> u7 W <br /> c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o <br /> z W n00 <br /> y <br /> Transcendent: - a n0 o <br /> Page 1 of 4 x w �' Q <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 3 c� <br /> o <br />