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LAND USE PERMIT APPLICATION- Burnett County, WI <br /> Applicant Complete All Sections Below This Line ' c <br /> a <br /> C7 <br /> Permit Types and Fees:(Please,check appropriate boxes) w <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 (�j 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 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> o r <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> r <br /> Filling/Grading $150 Boathouse $500 °^ <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1Year Extension-Allowed Once) $100 Cn <br /> w 70 <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. ro <br /> *Items not listed above will be treated as accessorystru es,such a :pergolas,landscaping,etc. 9 <br /> Property Owner's Name: J' 1 <br /> Property Owner's Mailing Address: "l AI � G'i`7 a <br /> City State Zip <br /> Property Site Address: a of <br /> Contact's Telephone Number: 5`r^ — -� 2g —727- o <br /> Contact's Email: '( <br /> Legal Description of Property: <br /> Section#: Town#:_D _N Range#: W Town of:-4-- <br /> o <br /> 0 <br /> *Attach additionalpage ifneededfor lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> Tax ID#(1-5 digit number;found on tax state nt): <br /> Proposed Use of Structure/ ddition: o <br /> Anticipated Start Date: Iri�9 ome/Cabin;Commercial Business;Bedroom;Deck;etc.) C7 <br /> Building Contractor: AV4 ISewer Installer: y <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z <br /> z <br /> � ff <br /> = Fee Rec: 15�� <br /> N Check#:�Ab <br /> Date of staff site visit: v Initials of site visit staff: <br /> APPROVED BY LAND SERVICES OFFICI DATE: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF yCn (� <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br /> � CD <br /> zz von c� <br /> r m c y-0 <br /> Transcendent: - Page 1 of 4 X — U0 <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 1/2019 < = fM <br /> m <br /> v <br /> a <br /> 3 <br />