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LAND USE PERMIT APPLICATION—Burnett County, WI r <br /> < ba <br /> Applicant Complete All Sections Below This Line c <br /> o. <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 ddition/Alteration to Dwelling/Principal Structure $200 OQ <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> o Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 � \ <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(iv)Structures $350 r <br /> Filling/Grading $150 Boathouse $500 ° 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 Cv, <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: V41x <br /> Property Owner's Mailing Address: 0101�t L 1IV^ N A( li Al <br /> @@ q t_ City State Zip n„ <br /> Property Site Address: 21��s / r,,t Q U 57Y 3 D <br /> Contact's Telephone Number: 7k' 3 -�'>10 <br /> Contact's Email: .V�(�J t G L ��� nl N K @.J l L1 S F Co /-A` <br /> n •, o <br /> Legal Description of Property: D( 5 n 0 N !� PS W iAG 10,5 60 C "6J <br /> Section#: �— Town#4Tz.,0N Range#: W Town of: -3ACA<5 Qc o <br /> C7 <br /> *Attach additional page if needed for e gthy 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): (/� 2—S <br /> Proposed Use of Structure/Addition: ?O I b T <br /> Anticipated Start Date: © ( (Home/Cabin;Commercial Business;Bedroom.Deck;etc.) C7 <br /> Building Contractor:plg +-LrV—C r—S Sewer Installer: y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: — <br /> C3��l Pew c`A-2. CIA �,�Si 5 Y� V� c� OA,ef2 z o <br /> -C) o'\\ &,2� b o, ,-1< 5 <br /> x Fee Rec: � <br /> Check#: <br /> Date of staff site visit: —7—/ 9— .�?6/7 Initials of sit visit staff: <br /> a <br /> APPROVED BY LAND SERVICES OFFICIAL: VDATE: 'moo <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF Cn <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT C � 00 [tUt <br /> 00 _ <br /> Transcendent: - Page 1 of 4 w ' _. <br /> � CC <br /> g <br /> Laserfische: - Burnett County, WI Land Use Application —Rev 1/2019 <br />