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LAND USE PERMIT APPLICATION—Burnett County, WI a ro <br /> Applicant Complete All Sections Below This Line ' o <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> CD <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 /> Driveways/&Campground Structures 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:per olds,landscaping,etc. r <br /> 0 <br /> Property Owner's Name: 6 )4-- k4le7+— ��o 0 <br /> Property Owner's Mailing Address: C?/, do <br /> City State Zip <br /> Property Site Address: c2(k 6- /O *J,2121--- �Z �d( < 0 <br /> Contact's Telephone Number: 71 739 -- 0737-7 Q) o <br /> Contact's Email:_ MZK <br /> Legal Description of Property: I~ S Vwt �JR�7D + P L n o <br /> Section#:�Town#: 3`( N Range#: /`� W Town of: tC oS� c <br /> d <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): /5­7 <br /> Proposed Use of Structure/Addition: S-(i"s <br /> Anticipated Start Date: 9/a//� / (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) d <br /> Building Contractor: TCe �64yvc_ r�,_ Sewer Installer: a SOS—C O y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 7 09 <br /> • �Oo c�e�n �hePS C-e.e���:n� i r � t'd u.n a z qk <br /> d\C t�a�-h-�o 5'Eo P wQrte c' Ord`^'� r kna,N3 OW n Eo <br /> h''k- f 1 Fee Rec: ��— <br /> o n f 6 V 5-t�e p 5 Check#:�7 <br /> Date of staff site visit: In' ials of site visit staff: r <br /> APPROVED BY LAND SERVICES OFFICI DATE: <br /> w <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT " m w <br /> o v 0 <br /> Transcendent: - <br /> Page 1 of 4 3 <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 <br />