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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 />2- <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 />Driveways/ & Campground Structures <br />$125 <br />Bunkhouse <br />$250 <br />1 <br />IWI State Statute 59.692(1v) Structures <br />$350 <br />Filling/Grading <br />$150 <br />113oathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />1 <br />IlDermit 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 'Y) ono Ck- <br />Property Owner's Mailing Address: l V`t i <br />Property Site Address: <br />Contact's Telephone Number: <br />CL <br />MN ,55L <br />State Zip <br />Contact's Email: m Y t' ono 565 rrxc - I ^ Co m. <br />t...F 3 Cem vZj Z►ri L-po-nLY PST CSM V1 P24''7 <br />Legal Description of Property: -d' 'PRT C5M V 3 Pq-;5- GOV LuT ? <br />Section #: 35 Town #: 4RNO N Range #: i JJ W Town of: �_%• k 5D to <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): J 1R81P <br />Proposed Use of Structure/ d ition: Irb e &yn Qy & C mQ <br />Anticipated Start Date: A) (Home/Cabin; Commerc 1 Business; Bedroom; Deck; etc.) <br />Building Contractor: K0-LkPPrnnn ZILLAdeYn Sewer Installer: <br />i)58-Ol <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED B LOW: <br />� ou�d/ �VA ,aeff4Kd ! g/i zal i -(�lJow <br />D - bps b ,�.�, y <br />D N k g U 1 `fit// 1.t G f d N re A4 o v a l► �L/ <br />U^tin!�7 /5 �!i` f 0 4Gc,e SSovy S/i'+.rCAl^GS, ne47vl PSI/' <br />DY{2 T� Lt us*--d �v' N14tAn4vl <br />0/z- <br />Date of staff site visit: ( Initials of site visit staff: i <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 />171 <br />0 <br />a. <br />w <br />5 <br />N <br />0 <br />0 <br />r <br />a 'a <br />\ d W <br />C <br />CD <br />o � <br />z <br />0 <br />CD <br />a. <br />C7 <br />b <br />bo <br />C4 <br />o � <br />k <br />d <br />z <br />s Fee Rec: <br />F7 Check #: 1 <br />d <br />