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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 />$300 <br />Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure <br />$300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) <br />$150 <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) <br />$200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Bunkhouse <br />$250 <br />Driveways/ & Campground Structures <br />$125 <br />WI State Statute 59.692(1v) Structures <br />$350 <br />Filling/Grading <br />$150 <br />1 <br />113oathouse <br />$500 <br />Six Month Camping Unit (One Per Year) 1$1001 <br />jPermit <br />Extension (1Year 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: pergolas, landscaping, etc. <br />p <br />Property Owner's Name:` <br />Property Owner's Mailing Address: <br />5),61` b n City State Zip <br />Property Site Address: S 96 � el ht�CC� <br />Contact's Telephone Number: /f ,Of 7 %f .71 �9 <br />Contact's Email:1S <br />Legal Description of Property: Z161-1—'m1�1?-Ykem L4 2. 7r}Op+C. <br />Section #: Town 4:5e:� t N Range #: W Town of: ,SCe1� <br />*Attach additional page if needed fo lengthy description OR attach a copyof the deed OR attach tax system property page.* <br />Tax ID # (1-5 digit number; found on tax statement): p ! <br />Proposed Use of Structure/Addition: G*i%h <br />Anticipated Start Date: (Home/Cabin: Commercial Business. Bedroom: Deck; etc) <br />Building Contractor:r—k,&I., h4 -71,Uh Sewer Installer: <br />IT <br />AmEA pr. L.V" 1ri1J L1iN L'rVK LA, ILJ'ClLKV1UL;J JI A r r I,ViV1ML1N 1J/1-ViN 0111V1V J ViV LY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELLOW: <br />�— ADD eacP4n s �0°1 � f��/"N� l <br />� ��,9G,t ®� e �4/ls 4,M <br />Date of staff site visit: Initials of site visit staff: <br />APPROVED B I' LAND SERVICES OFFICIAL: - BATE: <br />UPON APPROVAL: APPLICANT MUST 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 1/2019 <br />m <br />C <br />a <br />mC3 <br />�0 <br />C)o <br />o <br />v� <br />r) <br />31� <br />-- <br />CAD <br />