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LAND USE PERMIT APPLICATION — Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure <br />$300rAddition/Alteration <br />tion/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure <br />$300 <br />to Commercial/Industrial Structure <br />$200 <br />Accessory structure (Garage, Shed, etc.) <br />$150ion/Alteration <br />to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) <br />$200ion/Alteration <br />to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Driveways/ & Campground Structures <br />$125ate <br />house <br />Statute 59.692(ly) Structures <br />$250 <br />$350 <br />Filling/Grading <br />$150 <br />JBoathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 1 <br />jPermit Extension (1 Year Extension - Allowed Once) <br />$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. <br />*Items not listed above will be treated as accessory structures, such as: perqolas, landscaping, etc. <br />Property Owner's Name: <br />Property Owner's Mailing Address: <br />aG <56rx <br />3lnS w � t� G�4q; <br />de <br />City, State Zip <br />Property Site Address: Jet wt -r 4. s +6uv-f <br />Contact's Telephone Number: 715 7 3 3 ID 574 <br />Contact's Email: P!!!JP4, i rip 0 G,Ko: I • Go " <br />Legal Description of Property: #9-fr4 Gh e <br />Section #:gq Town #: 40 N Range #: /� W Town of:—y, <br />*Attach additionalpage 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): 5-4r03 <br />Proposed Use of Structure/Addition: d (4 Q t 1 o n- iZ ✓ 4 Trac -O /' <br />Anticipated Start DateSe P'r. / - a t� �(( 63 (Hom Cabin: Commercial Business: Bedroom: Deck; etc) <br />Building Contractor: 4jt%/ T�f k : d : +�� S' Sewer Installer: /V001 t <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />'3 <br />SCSDate of staff site visit: Initials of ite visit staf <br />PERMIT APPROVED B�' LAND SERVICES OFFICIAL• DATE: <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: <br />Laserfische: <br />Page I of 4 <br />Burnett County, WI Land Use Application — Rev 8/2018 <br />T <br />a <br />o' <br />a <br />0 <br />0 <br />l <br />c <br />h <br />M <br />11 <br />�. <br />V% <br />6 <br />;v <br />x <br />x <br />0 <br />m <br />o� <br />z <br />�1w <br />"9 <br />Fee Rec: , <br />� <br />Check <br />