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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> < b <br /> Applicant Complete All Sections Below This Line <br /> CD <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> 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 ( CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> 0 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 <br /> Filling/Grading $150 Boathouse $500 r <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> �S <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 /> CD <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. C. <br /> Property Owner's Name: R,r1 �)a t o 4 � <br /> / j o <br /> Property Owner's Mailing Address: ! 3 t 1 . Ave-- N.i5 TS(Gl;ne "A `� S�Y9 � � <br /> City State Zip C <br /> Property Site Address: -w?7 <br /> IC <br /> Contact's Telephone Number: <br /> Contact's Email: sec 1CD <br /> N b <br /> Legal Description of Property: 5 eC 3C +!\Yd 10 Y C'<r►1 i/?�; P/'� C i�'✓� o L oQ <br /> Section#:-36 Town#: 'C/(D N Range#: 16 W Town of: ( CA IC 0 <br /> d <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* q <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Adf� •itio ttf/>y1c / � t a <br /> Anticipated Start Date: 7('Z�I S' (Home/Cabin:Commercial Business;Bedroom;Deck;etc.) d <br /> Building Contractor: (D(Lnfir Sewer Installer: C t�X!►� 6 T U m�%�1, <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ¢� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 3 <br /> ---p1lQ%J cs.�` 5e�-bo.GKS per pcc��a•l�Ce P���'1 z 9' <br /> co <br /> H Fee Rec: — <br /> z <br /> E2 Check#: <br /> r <br /> Date of staff site visit: ✓`' Gam`'' V Initials of site visit staff: r^ <br /> G <br /> 16, __ <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: �- d ITc <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> CD 00 <br /> � Q <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> 0 (D r13_ <br /> Transcendent: - Page 1 of 4 CD <br /> ^' o <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 <br /> c ` � Q <br /> d <br /> ro <br />