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00 <br />LAND USE PERMIT APPLICATION - Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate boxes) s <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/IndustrialStrudure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) <br />$150 <br />Addition/Alteration to Accessory Structure <br />$150 <br />A essory Structure (Commercial/Industrial) <br />$200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />tair Patio/Retaining Wall/Sidewalk <br />Bunkhouse <br />$250 <br />DriXbe <br />veways/ & Campground Structures <br />$12 <br />WI State Statute 59.692(ly) Structures <br />$350 <br />Filling/Grading <br />$150 <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />1permit Extension (IYear Extension - Allowed Once) <br />$100 <br />*NOTE: After -the -fad permits (permit aquired after construction has begun) may cost up to three times the normal fee. <br />*Communication Towers & Signs require a different application form; see corresponding application, and fees. <br />*Items not listed above will be treated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: 1&,y JI f /i1e Z d ✓l 71 <br />/� n,, <br />Property Owner's Mailing Address: .S�l _5- V c N6- f" le/ W /t 121tvs <br />City State Zip <br />Property Site Address: c2 710 O ] de. Rb, 6C ZA% 4yCel W / 91 <br />Contact's Telephone Number: e:;/'. — s(o.7 <br />'—Belaa$ <br />Contact's Email: c w� i 6 e- Al -6 i Ll V � fT S-0 �g r„li4l,y� <br />�N e,. <br />Legal Description of Property: La'% &o es m v i / p /G r (,sEr /V E 4 <br />Section #:e,7,;- Town 4:.3 q N Range #:__l 7W Town of: L/ xJ C o /rJ <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): I O 3 3 -3 <br />Proposed Use of Structure/Addition: G n1 t. <br />Anticipated Start Date: b/a0/ (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />''// <br />Building Contractor: —,&Va crtry 4vkt S 77AVa/A�/fl Sewer Installer: 26�4A/i ,l <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDIT ONS LISTED BELOW: <br />o�-w ems' <br />Date of staff site visit: Z Initials of site visit staff: <br />APPROVED BY LAND SERVICES OFFICIAL: DATE: <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 />MNA <br />m <br />o � <br />� o <br />w <br />z <br />z <br />4z <br />Fee Rec: <br />Check #: <br />d5s3 <br />