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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 />ition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure <br />ition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) <br />ition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) <br />fi$200Addition/Alteration <br />ition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalkhouse <br />$250 <br />Driveways/ & Campground Structures <br />tate Statute 59.692(1v) Structures <br />$350 <br />Filling/Grading <br />house <br />$500 <br />Six Month Camping Unit (One Per Year) <br />it 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: pergolas, landscaping, etc. <br />Property Owner's Name:_ _ e (✓1�� <br />Property Owner's Mailing Address: / 0 (,° 7 ' <br />/� t City State Zip <br />Property Site Address: � 7d O 7 ` a J �7 /� �y n�f /``r - `� el � <br />fe <br />Contact's Telephone Number: /; - <br />!. <br />Contact's Email: P C -lrl H (,- G A &, iil % 0' <br />Legal Description of Property: �I epf Ad Sw Zy 0, -the-4e- cf.� �r�' r�F 5Z Y1V ;f ge- yr <br />Section #:�Town #:4)N Range #: / -7 W Town of: -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): Ir 5 51�? <br />Proposed Use of Structure/Addition: S'rar — ! " <br />Anticipated Start Date: (Home/Cabin; Commercial Business; Bedroom; Deck; etc) <br />Building Contractor: 5/?ej-, Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Date of staff site visit: � � � Initials of site visit staff: <br />APPROVED BY LAND SERVICES OFFICIAL: +�` <br />UPON APPROVAL: APPL CANT 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 />N <br />0 <br />5 <br />00 <br />C7 <br />y <br />0 <br />x <br />0 <br />m <br />o � <br />F <br />z � W <br />� w <br />Fee Rec: PC >' - <br />Check #: L ' <br />