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r <br />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 $300 Addition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br />AccessoryStructure (Garage, Shed, etc.) $150 Addition/Alteration to Accessory Structure $150 <br />AccessoryStructure (Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br />x Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(iv) 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: 1)o,v:44 p fAC. A S SO W <br />Property Owner's Mailing Address: `f & (? ,J PIZ/ AJC, C7A-t-7aW V A Y DAnlj30A <br />City State Zip <br />Property Site Address: rSl'� ?A <br />Contact's Telephone Number: I rc? 3W <br />Contact's Email: d L (VIII✓ E a He 7-m,41 e.- Ce y► <br />Legal Description of Property: % Spnly& &,gog ✓ 4&), 7y,,tl 7 ! �AoW R j/ <br />Section #: O Town #: �/ N Range #: 1 W Town of. 5 c d r 7 <br />*Attach additionalpage if neededfor 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): 12 3 req <br />Proposed Use of Structure/Addition: _P g C K ( REP 4AC4 ,/1) JLV ,47" <br />Anticipated Start Date: Or, Y I ° 19- (Home/Cabin: Commercial Business: Bedroom: Deck, etc.) <br />Building Contractor:_ K LG"jti/y'\/1?,'G.'T1 7A—' Sewer Installer: t7;c:&,*Pj) jlrP1'4tAlS <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />c k <br />Date of staff site visit: Initials of yite visit staff: p <br />PERMIT APPROVED BY LAND SERVICES OFFICI DATE: ' <br />UPON APPROVAL: APPLICANT M T 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 />Cn <br />a <br />;0 <br />fi <br />o <br />t7O <br />Jr <br />G <br />Q <br />4 <br />b <br />C <br />� <br />r <br />0 <br />0 <br />a <br />iy <br />� <br />n <br />N <br />a <br />0 <br />d <br />N <br />0 <br />ro <br />r <br />rQ <br />d <br />N� <br />n� <br />o <br />�Q <br />W <br />z <br />.gyp <br />z <br />r <br />Fee <br />Re : /�S <br />Check #:,28619 <br />v <br />m <br />NNW <br />