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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 />I <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(iv) Structures <br />$350 <br />Filling/Grading <br />$150 <br />1$100 <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />Permit 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 timesthe normal fee. <br />*Communication Towers & Signs require o different application form, see corresponding application, and fees. <br />*Items not listed above will be treated as accessorystructures, such as: pergolas, landscaping, etc. <br />�� NQ�u rat Soo c c'e <br />Property Owner's Name:_ e p q,Am-C nV rye S <br />Property Owner's Mailing Address: sf nlJ/. 5 OoK,( 5ygo( <br />City State Zip <br />Property Site Address: D _ N q k�D j i ti✓� y 8 �i <br />Contact's Telephone Number: 71 5 - 6 3 5 - V 011 �/ I <br />Contact's Email: /04K(y <br />b <br />Legal Description of Property: O V C.OT 3 <br />I L <br />Section #:), Town #: 0 N Range #: _W Town of: SG O -t'C <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): 17 60 -? <br />Proposed Use of Structure/Addition: (-0.1t0 / kA jrL �- I Ctn81 4 Mp GOVG yn G ►V{' <br />Anticipated Start Date: *on a(HomelCabin: Connnavi usiness; Be room; Deck; etc.) <br />Building Contractor:_ D A) ?-- ST a �- 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 />-- 54 0" I K a p �� G S/ ,7� G V� S S <br />Py <br />q 1?, <br />Date of staff site visit: S Z / Initials of site visit staff: <br />APPROVED BY LAND SERVICES OFFICIAL: ATE: 3 <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: - Page 1 of 4 <br />Laserlische: - Burnett County, WI Land Use Application — Rev 1/2019 <br />d <br />z <br />0 <br />a <br />w <br />ry <br />Fee Rec: Lja I Vt/d <br />Check #:�:F <br />w <br />:3 <br />a <br />3> <br />a) <br />-o <br />C� <br />CD <br />F .T <br />N <br />s� <br />00 <br />r <br />= <br />N.: <br />m <br />C <br />