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LAND USE PERMIT APPLICATION—Burnett County, WI r <br /> n � C <br /> Applicant Complete All Sections Below This Line C o <br /> a <br /> d <br /> Permit Types and Fees:(Please,check appropriate boxes) � <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 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 ~ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> 0 <br /> V Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r- <br /> Filling/Grading $150 Boathouse $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 squired 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. m <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r. <br /> z <br /> Property Owner's Name:_e&z:[,,/t /,q e, 0� <br /> Property Owner's Mailing Address: ro A v— T 15 O /3 <br /> City _ State Zip <br /> Property Site Address: ��//��e t� G/'T <br /> Contact's Telephone Number: o, <br /> C7 <br /> Contact's Email: 16L p P 7n L keN i gm', in4Q s c-O✓A <br /> Legal Description of Property: ®4(- c® i/mQ 6 0 <br /> Section# Town#: N Range#:�W Town of: <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system property page.* ti <br /> E <br /> Tax ID#(1-5 digit number;found on tax statement): A?Q q 9 <br /> Proposed Use of Structure/Addition: 40a-I 1C LZ CLL4 <br /> e/ <br /> Anticipated Start Date: 7/j j' Z Q' (Home/Cabin; ommercial Business;Bedroom;Deck;etc.) tj <br /> Building Contractor: S1�e v e— 11►`LP S C rT Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ZQ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 0 <br /> z W <br /> �o <�C reA tMP�w►e us s u ✓' cue <br /> —43 <br /> Fee Rec. lay <br /> y Check#: <br /> Date of staff site visit: g I Initials of site visit staff: <br /> 0 <br /> g z9 Zo <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF y <br /> I Q C� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT a W C <br /> m <br /> g g _ <br /> Transcendent: - Page 1 of 4 , (n n <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 D C o <br /> d R! C <br /> 3 <br /> b <br />