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r <br /> LAND USE PERMIT APPLICATION —Burnett County, WI t~ <br /> a <br /> Applicant Complete All Sections Below This Line ' <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 2, UJ <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 1 0 <br /> Accessory Structure(Garage,Shed,e . ?2S Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/I ndustrial) $200 Addition/Alteration to Bunkhouse $150 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 � <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 r. <br /> Filling/Grading $150 Boathouse $500 ° <br /> Kz <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Com w igns require a different app ication form;see corresponding application,and fees. ro <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. C. <br /> _ o <br /> Property Owner's Name: Ld <br /> Property Owner's Mailing Address: 1-- t O L& c.( ` &0 s <br /> City State Zip <br /> Property Site Address: act yq k t cQ )c,,o 62. <br /> �r <br /> Contact's Telephone Number: Cp( p P-� n <br /> o � <br /> Contact's Email: J K 8G2 �rvt�t Cc�r� <br /> Legal Description of Property: 0-7 0(-4 0 (� C�� � ��� C�o� lb)1(�p o <br /> Section#S�Town#: �N Range#:�W Town of. C A � <br /> t7 <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): <br /> Proposed Use of Structure/Ad itio 'trot" f x <br /> Anticipated Start Date: u (Home/ abi Comm rcial Business;Bedroom;Deck;etc.) C7 <br /> Building Contractor: Sewer Installer: C"— <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: �Q <br /> /"I GGGS$0i'` <br /> V`L1 w%et h � -rf t T l©yI . 49 P-1 N S/ 04 ee,,l 4 <br /> x Fee Rec: �G2 <br /> Check#: 3-3-716 <br /> d <br /> Date of staff site visit: -7 /q 1 9 Initials of site visit staff: D <br /> d <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: �i7i I m <br /> UPON APPROVAL: APP CANT MUST POST COPY OF t' <br /> a <•� r <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 <br /> z00 ry o <br /> Transcendent: - Page 1 of 4 o <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 <br /> a <br /> b <br />