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LAND USE PERMIT APPLICATION — Burnett County, WI b r <br /> Applicant Complete All Sections Below This Line <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> X Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <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 /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 jWl State Statute 59.692(1v)Structures $350 r <br /> 0 <br /> Filling/Grading $150 113oathouse $500 <br /> Six Month Camping Unit(One Per Year) $100 1permit 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. 9 <br /> *Communication Towers&Signs require a different application form,see corresponding application,and fees. CD �1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r• <br /> 0 <br /> z <br /> Property Owner's Name:(/7 Q E c� U R.,--i L/;-K S O H . R <br /> Property Owner's Mailing Address: 1 Jr 7 <br /> City State Zip <br /> Property Site Address: q1 v 1 LS L A 16 E R b weasT R- V\j j J y?)i3 <br /> 1/ o <br /> Contact's Telephone Number: 7l�' Ssb - 2-16 q J 64X m\4 NI L-L- a <br /> d <br /> Contact's Email: t Q Y f C�/� Z //c- �t 5/r U ,,[C o ri•J 7 e,mot, ID <br /> Legal Description of Property: � 0-r C S r'1 y Z(Q P (q'� (6 0 V C.OT Z. o ao <br /> Section#: �Town#: �N Range#:--L(O W Town of: 0 AK LA N h� � <br /> C7 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> o' <br /> Tax ID#(1-5 digit number; found on tax statement): 3 q&S <br /> Proposed Use of Structure/Addition: nOME <br /> Anticipated Start Date: 1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc) <br /> Building Contractor: H I L C ` OI1 S77Z%I C170a 1(C-Sewer Installer: I,1 m b4m 1 eL S - Hoexims p <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> • �oche peg m i-}�e c� -�r'` 3 .��a f Oo m S ��t�'sewe r' � � � <br /> Sy S�-e w� 5 i Z e-t- sqn� i-o-r y pe c v►^;�--. � oQ, <br /> x Fee Rec: <br /> Check "E47 <br /> �� � �� rri <br /> Date of staff site visit: � Initials of site visit staff: a <br /> z <br /> APPROVED BY LAND SERVICES OFFICIAL: �� "ATE: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF W c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT r` <br /> � � N <br /> Transcendent: - Pa e l of 4 Q 3 N c <br /> g M o Q <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 1/2019 3 `a <br /> m <br />