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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 />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:_ I !/t ✓l l �g 6 <br />Property Owner's Mailing Address:_��% <br />�i City Slate Zip <br />Property Site Address: r 7?5`,� n eo •• ep A <br />Contact's Telephone Number:^ 6� <br />Contact's Email:j,/ <br />Legal Description of Property: U c( ")—V(jo 000 <br />Section #: _ Town #: i 0 N Range #: W Town of. r© <br />*Attach additionalpage 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):� <br />Proposed Use of Structure/Addition: �%e 1 J <br />Anticipated Start Date:_�p D _ (Home/Cabin; Commercial Business: Bedroom; Deck; etc.) <br />Building Contractor: Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />TO CONDI/TIO/NS LIST/E_D BELOW: <br />ERMIT IS SUBJECT O� <br />/THUS <br />+ <br />/ V B 7 7`V �� Gl S e✓O i Wit/' i/ U �14 t1 !/l 4 lJ t �4 1`74� r <br />/�5(4u,M'9ij��57�7� <br />Date of staff site visit: Initials of site visit staff: <br />APPROVED BY LAND SERVICES OFFICIAL: DATE: ! P % Z <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 />a <br />z <br />x <br />r.I <br />Fee Rec: <br />Check #: " <br />C <br />' <br />LI u LI <br />a U) <br />co <br />Z Z <br />r CD r. <br />tra <br />LI <br />U! 0 <br />00 <br />r LI t1 <br />O <br />a CD <br />fD <br />Ln <br />j(� <br />