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LAND USE PERMIT APPLICATION— Burnett County, WI t~ <br /> ate. 3 C <br /> Applicant Complete.All Sections Below This Line <br /> Per it TypesFees:and (Please,check a p ppropriate boxes) <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 rn <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 .� O <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 �1 <br /> V� eck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 0 <br /> ,Dlriveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 <br /> Filling/Grading $150 Boathouse <br /> $500 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 <br /> v <br /> *NOTE:After-the-fact permits(permit aquired after construction has begun)may cost up to three times the normal fee. v <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,landscap' g,etc. 3 <br /> Property Owner's Name: <br /> ��^^ <br /> r t <br /> Property Owner's Mailing Address_X Ilk LZ �ta r q 4�3Jj , <br /> n <br /> Property Site Address:4)—)4 C( CA <br /> Contact's Telephone Number: 2._ <br /> Contact's Email: r y Q L <br /> p M1� <br /> Legal Description of Property: L S Vr �- f �� 4- P C L 'J 16 j p � <br /> Section#: Town#: 0 N Range#: W Town of. ® �t `1 <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 statement): 63. <br /> Proposed Use of Structure/ don 3 r N� C 41• ,� <br /> Anticipated Start Date: (Home'Cabin;Commercial Business:Bedroom;Deck:etc.) <br /> z <br /> Building Contractor: G(1 H U 7 Sewer Installer , Ru Q��►� <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Q <br /> z <br /> Fee Rec:,3r)O <br /> Check#: <br /> Date of staff site visit:— <br /> }4 �v <br /> v" Initials of site visit staff: <br /> C � <br /> z <br /> APPROVED BY LAND SERVICES O DATE: iQ �] <br /> r <br /> UPON APPROVAL: FPPLIcANT MUST POST COPY OF a a <br /> s C W G <br /> c <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT ^' <br /> z y 0 ,v <br /> O <br /> Transcendent: - x <br /> Page 1 of 4 n K <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 <br /> y i�I <br /> 4 <br /> 2 <br /> ..J <br />