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LAND USE PERMIT APPLICATION — Burnett County, WI Cn r 7"- b <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 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 �Q <br /> E <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 IWI State Statute 59.692(1v)Structures $350 C. <br /> 0 <br /> Filling/Grading $150 lBoathouse $500 <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 /> *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. r. <br /> 0 <br /> / z \ <br /> Property Owner's Name: �yy �KA t" Cc✓,tf <br /> Property Owner's Mailing Address: 330-7 1Av,-,►5Lj LP Al l .Ss-33 7 111 <br /> C `_/ City State Zi <br /> Property Site Address: � 77� C. ����V`+0 �' �1 �.� �� <br /> Z- Z70 - Y� 7 Contact's Telephone Number: a <br /> d <br /> Contact's Email: 0� ' Dn- QC J <br /> Legal Description of Property: 4`3 1'�✓ (rK/S 7r Z (/ bl /�7t fn cL � S ��Z, 0 o0 <br /> Section#: D Town#: W Townof: C� rro <br /> d <br /> *Attach additional page if needed for lengthy description OR attach a copy <br /> Lof/the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): I 6 / Cn <br /> p �� �Proposed Use of Structur Additi9n: &os g� x <br /> Anticipated Start Date (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) d <br /> Building Contractor:MrAh6eld Aj40s 40!�r 'k- Sewer Installer: 0 y <br /> 1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Itz <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS IST D BE OW: <br /> o k,0 1—��' �(On . z <br /> y Fee Rec: La <br /> x <br /> _ Check <br /> Date of staff site visit• Initials of site visit staff: Cn <br /> l� <br /> d <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF Cs� <br /> 11 a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z a 9 � <br /> rl CD v = N <br /> Transcendent: <br /> Page 1 of 4 <br /> _Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 (� <br /> d � <br /> y <br /> a <br /> ro <br />