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LAND USE PERMIT APPLICATION -Burnett County, WI C CDr <br /> a <br /> Applicant Complete All Sections Below This Line ' <br /> s C7 <br /> Per it Types and Fees:(Please,check appropriate boxes) <br /> Dwelling/Principal Structure =°$300rAddition/Alteration <br /> ition/Alteration to Dwelling/Principal Structure $200 n <br /> Commercial/Industrial Structure $300ition/Alteration to Commercial/Industrial Structure $200 <br /> Accessory Structure(Garage,Shed,etc.) $150 to Accessory Structure $150 \ <br /> Accessory Structure(Commercial/Industrial) $200ition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk khouse $250 <br /> 0 <br /> Driveways/&Campground Structures $125tate Statute 59.692(1v)Structures $350 r <br /> Filling/Grading $150 Boathouse $500 0 <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. CD <br /> not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. S C ^ <br /> Property Owner's Name: I.--Aa l k)��<nn 6' <br /> Property Owner's Mailing Address: 9, <br /> +l1 <br /> Uf, . <br /> $ rt., <br /> ity S to a, 'A <br /> Property Site Address: Aq { N a yl _ ouc:� �— U 4 <br /> o <br /> Contact's Telephone Number: a <br /> Contact's Email: Kul <br /> (� cn <br /> rr)100 <br /> Legal Description of Property:EoAnw��u�� - 0 <br /> Section#: Town#:_ LLa_N Range#:-4—W Town of:y�(�(' C(�n ago <br /> t� <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): a 7 <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: 4{A,,cu- r `j. Q0 ICI (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) w C7 <br /> Building Contractor: V a Ul san Sewer Installer: <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> • �46�se, ►,30-r— -t- 3 z <br /> Fee Rec: � <br /> 55 3 <br /> Check#: /C V <br /> r �{ Y <br /> Date of staff site visit: � I itials of site visit staff: ,�t d <br /> APPROVED BY LAND SERVICES FFI A ATE: V✓ �� <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF W e <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> O <br /> Transcendent: - Page 1 of 4 o <br /> Laserfische: - Burnett County, WI Land Use Application-Rev 1/2019 <br />