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LAND USE PERMIT APPLICATION — Burnett County WI <br />Applicant Complete All Sections Below This Line 3' <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure $3001 1 Addition/Alteration to Dwelling/Principal Structure $200'— <br />Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 l% �O <br />Accessory Structure (Garage, Shed, etc.) $150 Addition/Alteration to Accessory Structure $150 <br />CD <br />Accessory Structure (Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 o G <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < <br />Tj <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(1v) Structures $350 r- n <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 />z <br />Property Owner's Name:_On IY (ha CL) // o <br />Property Owner's Mailing Address: v2d� <br />City State Zip <br />Property Site Address: <br />Contact's Telephone Number: elk 3q - 2 O '� C4 oCD <br />a. <br />C7 <br />Contact's Email: <br />Legal Description of Property: <br />Section #: ` Town #: -5? N Range #: W Town of. J o <br />b <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): CA <br />Proposed Use of Structure/Addition: ° k <br />Anticipated Start Date: (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) C7 <br />Building Contractor: -� <br />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 />z <br />— Fee Rec: <br />_ Check #: <br />Date of staff site visit. ( Initials of site visit staff: A <br />q z <br />APPROVED BY LAND SERVICES OFFICIAL: DATE: 3� <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT o o <br />QTranscendent: - 3z S <br />Page 1 of 4 <br />Laserfische: - Burnett County, WI Land Use Application — Rev 1/2019CD <br />a <br />