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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line <br /> 0. <br /> Permit Types and Fees:(Please,check appropriate boxes) <br /> i5 <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 /> E <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 $125 jWl State Statute 59.692(1v)Structures $350 r <br /> 0 <br /> Filling/Grading $150 lBoathouse $500 <br /> Six Month Camping Unit(One PerYear) $100 1 jPermit Extension(1 Year Extension-Allowed Once) $100 W <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. �a <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. Ir• 3 <br /> o <br /> Property Owner's Name: �&6fk,. Y LtS j G <br /> n o <br /> Property Owner's Mailing Address: Z�Y — Z v�� /`, Ai k;Ao Mp- 57 `' <br /> -� City State Zip <br /> Property Site Address: ZS //ie s sh Liy 84• , L^A�4 - &—r S'yoo f 3 <br /> Contact's Telephone Number: &57— YYZ — lto /69 -31(4- o � <br /> 0 <br /> Contact's Email: '7" /K Q3—, A4C..00 IttA4., <br /> Legal Description of Property: PA VM t (.oG-:k4A �- (�bJ t T (a-I 3 �S<C. "� �"'� o o� <br /> Section#: 3LP Town#: Ya N Range#: _W Town of: �S4,cA,.S pk_ <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 /> Tax ID#(1-5 digit number;found on tax statement): (.p 3 <br /> Proposed Use of Structure/Addition: (GA bt x <br /> Anticipated Start Date: 4Q 0 i f 1 j'LAks (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ° C7 <br /> Building Contractor: k�kS SAn�+ Lgro-v� Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF CO-NENIENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 0 \,J <br /> ,7 'A�- �i e-ed 71v /0�47 '17" <br /> 119 <br /> Fee Rec:�a5 <br /> Check#:,� <br /> p <br /> Date of staff site visit: ILO Initials of site visit staff: <br /> zg� <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF a <br /> T <W C= � <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z CD <br /> y O _ <br /> Transcendent: - Pagel of 4 T w o <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 < <br /> m CD <br />