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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 />1 <br />Addition/Alteration to Bunkhouse <br />$150 <br />XDeck/Stairs/Patio/Retaining <br />Wall/Sidewalk <br />lDriveways/& Campground Structures <br />$125 <br />Bunkhouse <br />$250 <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 />1 <br />Permit Extension (1Year 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: gy-f' 4<j' l -T, Tu C C. <br />~n <br />j ,-� <br />o° <br />Property Owner's Mailing Address: t8a 3 Cy A[?,ALCR L Iv hDEn1 RIAI) 9 mA1 553y6 41- <br />City State Zip <br />Property Site Address: <br />M <br />Contact's Telephone Number: 61 a b 3 S (o 7751 <br />Contact's Email: iZ1e } PYZQ TT OC-C ( C& C Yy) : ') L . Co✓Yl <br />Legal Description of Property: 5 a 4 7i <br />Section #: 2r Town #:�N Range #: <br />W Town of: <br />*Attach additional page if needed for lengthy description OR attach acopy of the deed OR attach tax system property page. <br />Tax ID # (1-5 digit number; found on tax statement): ) at 1 6 1 <br />Proposed Use of Structure/Addition: 02m rr <br />Anticipated Start Date: e701 !3 (Home/Cabin; Commercial Business; Bedroom; Deck; etc) <br />Building Contractor: AME91CA4 J40141; 5 N,4YWAkA Sewer Installer: 1301Q!k P&W INC . <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Nf'�-/9 <br />0LtAC4WPj1) ply <br />Date of staff site visit: S 3 Initials of site visit staff: A <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 />on <br />r <br />b <br />,�A <br />LVE <br />WN <br />Fee Rec: V#I 1,� <br />Check #: 5 <br />r <br />C <br />�y <br />(J <br />m c� <br />(D <br />SD <br />fV <br />o <br />3 <br />m <br />c� <br />