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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 />$300rAdd <br />ion/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure <br />$300ion/Alteration <br />to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) <br />$150ion/Alteration <br />to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) <br />$200ion/Alteration <br />to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />house <br />$250 <br />Driveways/ & Campground Structures <br />$125ate <br />Statute 59.692(1v) Structures <br />$350 <br />Filling/Grading <br />$150 <br />Isloo <br />1 <br />lBoathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />I <br />1permit Extension (1 Year Extension - Allowed Once) <br />$100 <br />*NOTE: After -the -fact permits (permit aquired after construction has begun) may cost up to three times the normal fee. <br />*Communication Towers & Signs require a different application form; see corresponding application, and fees. <br />*Items not listed above will be treated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: Rob.'RT K zuO&E-Z <br />Property Owner's Mailing Address: I I i 0kF P6T ST S 6" &-e$ET wi 402, <br />City State Zip <br />Property Site Address: -.9 (— A& Y r= r LE P-0 <br />Contact's Telephone Number: (p9l - 201- - 9-703 <br />Contact's Email: J - <Q @ ,SottA-r (. A) E7" <br />Legal Description of Property: —r*t L yz o-P 7iW IV W yq <br />Section #: 22. Town #:__39N Range #:_ 2 W Town of: W CST X4A1Z5;#LlA1U <br />*Attach additional page if neededfor 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): 7 <br />Proposed Use of Structure/Addition: C prQ l lV <br />Anticipated Start Date: MIRY 1 Z019 (Home/Cabin; Commercial Business; Bedroom; Deck; etc) <br />Building Contractor: rc -r Kew er,E a Sewer Installer: ��ty , f�►_ ,qU/a�-jam <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />�ru%A <br />Date of staff site visit: Initials of site visit staff: ' <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 />I <br />r <br />� b <br />N `^ <br />� v <br />O <br />F <br />�a <br />m� <br />0 0 <br />1 <br />O <br />IN <br />C7 <br />1 <br />o � <br />F <br />0n , <br />\v <br />y 2,.�,, �� Fee Rec: �c� u <br />x <br />Check #: 31 eg <br />0 <br />m <br />r <br />a <br />�� <br />a, <br />Do <br />00 <br />o <br />m <br />