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LAND USE PERMIT APPLICATION - Burnett County, WI r <br /> b <br /> Applicant Complete All Sections Below This Line c <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) w � <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) $20 Addition/Alteration to Bunkhouse $150 d <br /> G� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 ° <br /> v Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 r <br /> 0 <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 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. C- <br /> // o <br /> Property Owner's Name: ��yt!a l� L ero k 4-- z <br /> 0 <br /> 0 <br /> c <br /> Property Owner's Mailing Address: <br /> City State Zip <br /> Property Site Address: 7 C-,, ya y W-T <br /> S�{ 3Ti2. <br /> Contact's Telephone Number: 71 ,s '' 3 5 �} n <br /> d <br /> Contact's Email: V©L,FI'V A <br /> Legal Description of Property: S i/ (G S'i AVM LC)( 3�Z (r(���f EX cs e ✓I ip a� <br /> Section Town#: _N Range#:1(,o W Town of: ,,yv,s3 <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> 0 <br /> Tax ID#(1-5 digit number; found on tax statement): 2 2 f' ? Ir <br /> Proposed Use of Structure/Addition: 17e C-h- — `Per S T�rvfd r a £ k <br /> Anticipated Start Date: (Home/Cabin;Commercial Busin s;Bedroom;Deck;etc.) ° C7 <br /> Building Contractor:��q�4CZ�61 Sewer Installer: /Vj'f <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ^, J <br /> z <br /> x <br /> Fee Rec: tt2 ©u <br /> Check#4!�;34) <br /> Date of staff site visit: t/ ! Initials of site visit staff: r —� <br /> o <br /> Z 9 zo/9 <br /> APPROVED BY LAND SERVICES OFFICIAL: ..._DATE: 8 z m <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> a <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 y 0 <br /> -ZC D= CAS C <br /> C <br /> Transcendent: - Page 1 of 4 <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 <br /> a <br /> b <br />