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LAND USE PERMIT APPLICATION— Burnett County, WI <br /> r <br /> Applicant Complete All Sections Below This Line o N <br /> 6 <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure A$1225 <br /> Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure Addition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) Addition/Alteration to Accessory Structure $150 <br /> 3 <br /> Accessory Structure(Commercial/Industrial Addition/Alteration to Bunkhouse $150 <br /> C� <br /> Deck/Stairs/Patio/Retaining Wall/SidewalkBunkhouse $250 0 <br /> Driveways/&Campground Structures IWI State Statute 59.692(Sv)Structures $350 �. <br /> Filling/Grading $150 1 113oathouse ° <br /> $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(I Year Extension-Allowed Once) $100 <br /> d <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. d <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 /> � o <br /> Property Owner's Name: ��<<<= ���x� �( o c ° <br /> UJ� <br /> Property Owner's Mailin <br /> City State Zip R. y <br /> Property Site Addr ss: S �� — 5 C] Z � 3-1 <br /> Contact's Telephone Number: <br /> Contact's Email: Y \ r C�(Y\P ``j 5 C- D <br /> nn <br /> Legal Description of Property: f�� ' d�'�r`g �-�,y <br /> Section#: c Town#: y 0, N Range#: I W Town of: 56 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page.* <br /> Tax ID#(1-5 digit number; found on tax statemen <br /> Proposed Use of Structure/Addition: �e'C): 5 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business:Bedroom:Deck:etc) <br /> Building Contractor: Sewer Installer: <br /> AREA BELOW THIS LIVE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY Ur <br /> THIS PERMIT IS SUBJECT Tn AT T '' )NDITIONS LISTED BELOW: <br /> ceed :�00 '57. �-f- 00, <br /> Fee Recjj` <br /> (v s Check#: <br /> Date of stall site visit: �a0 �d110 1 9 1In• ials of site visit staff: <br /> APPROVED BY LAND SERVICES OFFIC DATE: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF �W <br /> < M <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z �, <br /> Do fl <br /> Transcendent: - Pa e 1 of 4 J N <br /> m � <br /> Laserfische: - Burnett County,WI Land Use Application —Rev 1/2019 co <br /> D <br />