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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line o <br /> a W <br /> Permit Types and Fees:(Please,check appropriate boxes) U� <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 (`►O <br /> E <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 e <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 r, <br /> 0 <br /> Filling/Grading $150 lBoathouse $500 <br /> Six Month Camping Unit(One Per Year) 1$1001Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form,see corresponding application,and fees. r\ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> \ t z <br /> Property Owner's Name: \�us's: �J\t`. CNN <br /> Property Owner's Mailing Address: Z 11 d , <br /> City State Zip <br /> Property Site Address: 2 T 44 1 S 3 C <br /> o <br /> Contact's Telephone Number: —115 S1 A - (�,8$ kA o <br /> d <br /> Contact's Email: 0. , �a�crop• .�6 tv` <br /> Legal Description of Property: 0 o <br /> Section#: -14 Town#: 40 ' N Range#: W Town of: V(\ bn <br /> 0 <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): <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ° p <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 7_ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 3 T" <br /> • (yRa, n�6�r 1t� s-\( (e 5-,� b <br /> �r1 Ilie� l��ceSS Cor�',`��or ��r �vunY <br /> Fee Rec: <br /> Acj- � 5�` Check#:-y(1-9 <br /> Date of staff site visit:�— ��aGinitials of site visit staff: � D <br /> z �j Q <br /> APPROVED BY LAND SERVICES OFFICI DATE: ao �.0 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF W `� <br /> T <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 mc 0 �'II <br /> PJ c <br /> Transcendent: <br /> Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2020 w <br /> a <br /> 3 <br />