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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 />$300I.Wl <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) <br />$150Addition/Alteration <br />to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) <br />$200Addition/Alteration <br />to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Bunkhouse <br />$250 <br />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 -fad 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: Al�Le ",® 8 L / c':•v ,' ,./'Ts7 <br />Property Owner's Mailing Address: 30%/ /'�% r ,.t i ✓ a rr. <br />City State Zip <br />Property Site Address:-30//`V Ith .t-1611*'t 40—% ,� � 414-.l b74 •c% W,T 54w,3c? <br />Contact s Tele hone Number: <br />' p 1- 7(3-- Z4:5 - 6i50-76C) 3' <br />Contact's Email:,Q7-4C/<,K 4P 60w7 co95r. /YCrT <br />Legal Description of Property: 4-e ,)- ( 7— Z4S <br />Section #: 35 Town #:_4_L_N Range #:..W Town o£ � � % S S <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): sttatement): 'Z Z4P 4 6 <br />Proposed Use of Structure/ ddition�: 4� T T—e 301 X 3 2-1 <br />Anticipated Start Date: /6i' f 05 /0 70 / (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: Ott 4,ev- Sewer Installer: /V/O <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF C:O.M.NI ::V US/C:O-ND11'IONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />� �ij U S � �!/' A "f xn c' N !�l �t l0 I a �Tni1. <br />3 1 <br />Date of staff site visit: 7 / Initials of site visit staff: / 1 <br />APPROVED BY LAND SERVICES OFFICIAL: DATE: % <br />UPON APPROVAL: APP ICANT 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 />0 <br />0 <br />a. <br />w <br />5 <br />0 <br />0 <br />9' <br />r <br />0 <br />N <br />n <br />CA <br />0 <br />z <br />c <br />G. <br />d <br />CD <br />z <br />0 <br />n <br />d <br />0 <br />F <br />7 <br />(A <br />r <br />b <br />{Y <br />N <br />A <br />i <br />Fee Rec: �— <br />Check #: <br />w <br />Cn <br />Cn co <br />C <br />ci (D <br />N <br />FU <br />ccn C <br />_.. <br />v0 <br />�2 <br />N <br />a C <br />�� <br />M <br />a <br />