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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 />$30Q <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 />00 <br />Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Driveways/ & Campground Structures <br />$125 <br />Bunkhouse <br />$250 <br />WI State Statute 59.692(1v) Structures <br />$350 <br />Filling/Grading <br />$150 <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 <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 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: C am✓bi-olrnbercw <br />Property Owner's Mailing Address: 010846 E. \) t7 -;V Ir 5483� <br />Property Site Address: SYI City State Zip <br />Gtr <br />Contact's Telephone Number: �,5 1 ) 7 88 <br />Contact's Email: Woo M Gt. ✓1 -4(o 1 r7 2 CA � ,r 1. C i, rvn <br />Pct.roiuh`S P,-,Ne.s, Lot 33 %6�'�d ,d <br />Legal Description of Property: r" O„� Lots j , Z> . qt 3 <br />Section #:_] Town #: q D N Range #:-J�-w Town of: 00 e 14 A Ole <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br />Tax ID # (1-5 digit number; found on tax statement):_ .44 �.?— 405 <br />Proposed Use of Structure/Addi ion: �% X 44 b P O l e— -8Q r n <br />Anticipated Start Date: 4 19 (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: /JQII-kl I a.rVt Rho i Idtl-1 ,Ts Sewer Installer: <br />BELOW THIS LINE FOR LAND SERVICE5STAFF CONI-NIENTS/CONDITIONS ONI <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />— Nof 7-/v d e- "se-0/ -fir �V"lia0 A /0/A4d`vl, <br />Date of staff site visit: / % 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: - Pagel of 4 <br />Laserfische: - Burnett County, WI Land Use Application — Rev 1/2019 <br />r <br />a � <br />a <br />m <br />O <br />CD <br />o <br />r � <br />0 <br />Cn <br />m <br />0 <br />m� <br />b <br />� r <br />0 <br />0 <br />z <br />0 <br />0 <br />0 <br />m C] <br />Cn <br />4 <br />o N <br />o. <br />C7 <br />o <br />5' <br />00 <br />C7 <br />VJ <br />'t <br />A <br />X <br />o � <br />CJ <br />z <br />z Fee Rec:�_ <br />y Check #: i �?f l <br />U. <br />3 <br />