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" LAND USE PERMIT APPLICATION - Burnett County, WI a C b <br /> Applicant Complete All Sections Below This Line <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure $300 1 X I Addition/Alteration to Dwelling/Principal Structure <br /> Commercial/Industrial Structure $3001 1 Addition/Alteration to Commercial/Industrial Structure $200 OQ <br /> F <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 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Drivewa s/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r- <br /> 0 <br /> Filling/Grading $150 Boathouse $500 <br /> Six Month Camping Unit(One Per Year) 1$1001 jPermit Extension(I Year Extension-Allowed Once) $100 <br /> *NOTE:Aft—the-fictmits(permitaquire aterconstruction has begun)may cost upto three times the normalf <br /> *Communication Towers&Signs require a different application form,see corresponding application,and fees. ro <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r- <br /> 0 <br /> Property Owner's Name: ""A Q%-k C <br /> Property Owner's Mailing Address: ; ®?6 �4�4iJ` !`` I �- 5,V 09 0 <br /> _ City Sate Z' <br /> Property Site Address: yZ'-� C/�✓^i, �� '� to <br /> S <br /> o <br /> Contact's Telephone Number: <br /> Contact's Email: G(ter r Ey L z C— 6L PU/v 4 d - L y t -"- <br /> ^ , <br /> Legal Description of Property: : �o -0 <br /> Section#: �Town#: 40 N Range#: W Town of: l t S &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 /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: CU(i{��� t�� � o <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ° C7 <br /> Building Contractor: 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: C <br /> x Fee Rec: 3yd <br /> Check#:l LO L14 <br /> '7 <br /> p d <br /> Date of staff site visit: 0 2 r Initials of site visit staff: r a <br /> 'q� - <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE:9 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF W W <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT Q, [� <br /> Transcendent: - Page 1 of 4 0 g o Q <br /> cs� <br /> Laserfische: - Burnett County,WI Land Use Application— Rev 1/2019 <br /> b <br />