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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 />jWl State Statute 59.692(1v) Structures <br />$350 <br />Filling/Grading <br />$150 <br />lBoathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />1permit 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: � °L-b�)i E L L) T <br />5512- <br />Property Owner's Mailing Address: 537 I-4 A W1-I4 0A E-W00Z%S1DfL I -A AVV hA jA n. <br />City State Zi <br />Property Site Address: 27958 j �, °L (p11� �� lV TJA,a�B�a2 wT 3p��3 <br />Contact's Telephone Number: bV-061 1PEPt�CVk, 715-.5(06-2--13 5- <br />Contact's Email: biq d , P °Lte 12.5 Vv., W l C? ey m ail • L o yVl <br />Legal Description of Property: 0 % — © 'Z ^� 30 �' rj �'S ` S 8S - d 1 b 00/q <br />Section #: 3 0 Town #: 'A 0 N Range #:__II_W Town of _ �} I�' j C) t j <br />*Attach additional page if needed for lengthy description OR attach a co��p**y,, of the deed OR attach tax system property page. <br />Z 5 5 JO <br />Tax ID # (1-5 digit number; found on tax statement): lJ <br />Proposed Use of Structure/Addition: Cc <br />Anticipated Start Date: M 0, y 10 T-H (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: '�� E V�, (-() NL 5 T— Sewer Installer: K)Q 1 <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />- 71V Mew <br />Z9�/ q <br />Date of staff site visit: Initials of site visit staff: <br />s z� <br />APPROVED BY LAND SERVICES OFFICIAL: DATE: <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 />0 <br />0 <br />a <br />5 <br />N <br />0 <br />U <br />2 <br />--1 <br />Fee Rec: <br />Check #: cL33 3 <br />d <br />r� <br />z <br />0 <br />�r <br />z� <br />a m <br />N <br />N <br />C� <br />O W C <br />N <br />0 <br />cm <br />0 <br />