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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 />fi;ommercial/Inclustrial 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 />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Bunkhouse <br />$250 <br />WI State Statute 59.692(ly) Structures <br />$350 <br />Driveways/& Campground Structures <br />$125 <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: a Q,, he- D X 0. v, INe- <br />Property Owner's Mailing Address: So Ci CAr'� S S r e �f ��-��C� �✓` �,✓l� sy�� <br />State <br />'f9'%S L4 .4 City State Zip <br />I � ` <br />Property Site Address: a � � ��5 <br />Contacts Telephone Number: m <br />Contact's Email: L--+y K h z t V" Gf� V� �r1 DO C.O w� <br />Legal Description of Property:_ (jest qqo r t)oa'f' 4 ,)Oyt i��`� r ©'� &,dg Ije <br />Section #:�_ Town #: L QN Range W Town of. �'a C�% mg ✓y <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): 3 Z 7 / <br />Proposed Use of Structure/Addition: (tje.- <br />Anticipated Start Date: f ,7- 2,V 1 — -(Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: ,SQ�� Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITION/ S LISTED BELOW: <br />_. /)0. /�e- u5 C 01 - ie � t4 IM 4 v1 A u 1 //1- 770/ 1 <br />Date of staff site visit: cP % Initials of site visit staff: <br />APPROVED BY LAND SERVICES OFFICIAL: - - DATE: �7 <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 />0 <br />o' <br />o w <br />� x <br />� d <br />ti <br />\v <br />z � � <br />x C) <br />Fee Rec: <br />Check #: �, 27� % <br />0 <br />r� <br />v <br />n <br />y °WCD <br />z <br />O 00 <br />z ra <br />k o <br />QQ < <br />C <br />m <br />C <br />a <br />