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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 $300Addition/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 X 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 />Filling/Grading $150 Boathouse $500 <br />Six Month Camping Unit (One Per Year) $100 Permit 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. <br />*Items not listed above will be treated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: <br />Property Owner's Mailing Address: Sf 1;j <br />rty State Zip <br />Property Site Address: a 5oy� <br />Contact's Telephone Number: /OS/ -ags'I G da c, <br />Contact's Email: !e 41'73e Q -M s a- G n+r <br />Legal Description of Property: rn 1 UVt A'( a Assessors -Pl &t I LD t 3 <br />Section #: .3 q Town #: - N Range #: / (v W Town of: M 4 -(. . y� <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): 1 al 30 <br />Proposed Use of Structure/Addition: S` � 5.t- 10)(S,) - <br />Anticipated <br />0 )( 3,)- <br />Anticipated Start Date: (Home/Cabin; Commercial Business; Bedroom; Deck; etc) <br />Building Contractor: Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIO S LISTED BELOW: <br />M a,I be- � cc) <br />rr--) PFROV[D <br />Date of staff site visit: Initials of sit visit staff: L <br />PERMIT APPROVED BY LAND SERVICES OFFICIA DATE: <br />J <br />UPON APPROVAL: APPLICANT UST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: - Page 1 of 4 <br />Laserfische: - Burnett County, WI Land Use Application — Rev 8/2018 <br />� <br />c <br />o <br />ro <br />a <br />v <br />o" <br />a <br />ti <br />CD <br />n. <br />w <br />e <br />w <br />_5 <br />� <br />5 <br />z <br />O <br />" <br />o <br />_, <br />C <br />0 <br />= <br />OQ <br />0 <br />aU <br />Fee Rec:� <br />o <br />Check #: <br />&__ <br />CD <br />'s9 ✓ <br />1 ^l o <br />V v <br />or <br />ro��11" <br />m <br />C7 <br />� <br />y <br />a <br />d <br />w <br />i9 <br />o <br />0 <br />ao <br />5' <br />00 <br />d <br />Cn <br />M <br />-t, <br />N <br />0 <br />co <br />o <br />v <br />y <br />w <br />_5 <br />z <br />O <br />a� <br />aU <br />Fee Rec:� <br />Check #: <br />&__ <br />Cn <br />M <br />-t, <br />N <br />0 <br />co <br />