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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This LineCD <br /> o <br /> a <br /> a <br /> Permit Types and Fees:(Please,check appropriate boxes) d <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 1 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 s� <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 CD <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> G) (� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 �• <br /> 0 <br /> Filling/Grading $150 lBoathouse $500 <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r. _ <br /> ' o <br /> EIi {�, �c6t►-e�( �� z <br /> Property Owner's Name: <br /> Property Owner's Mailing Address: T 5`{'S kd cx e- ( Yc I e �rt�{k.lr�,�a✓ �j SY�l3 <br /> o <br /> / City State Zip <br /> Property Site Address: Q S 53o /3�c( e lg'rru `Ct�' �fi�tip=.-v w r <br /> o <br /> � <br /> Contact's Telephone Number: <br /> d <br /> Contact's Email: C 1(y e SN tit V U h GcJ. Lc iM <br /> Legal Description of Property: FGt,rte( (.ct t I- fr-"Aces1 A yu f h-`I o v� <br /> Section#: Town#: � N Range#: i W Town of. <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): <br /> Proposed Use of Structure/Addition:_ 0, <br /> � a <br /> Anticipated Start Date: "?- )t-i l (Home/Cabin;Commercial Business;Bedroom;Deck;etc) C7 <br /> Building Contractor: Se( jp Sewer Installer: <br /> AREA BELOW THIS LINE FOR I.AND SERVICES STAFF COMMENTS/CONDITIONS ONLY 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LIST BELOW: <br /> X L1� (z ' z UI <br /> Fee Rec:_ <br /> Check#: Iwo <br /> Date of staff site visit: ✓ Initials of site visit staff: <br /> Q <br /> APPROVED BY LAND SERVICES OFFICI '"t�� lo-" dal1 r- <br /> w95 <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF W <br /> 5_=3 <br /> [�tr <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT o y 0 N <br /> 2 vo c <br /> Transcendent: - _ Page 1 of 4 Ei W'` c <br /> Laserfische: - _ Burnett County, WI Land Use Application —Rev 1/2019 m f� <br /> d. <br /> a <br /> 5 <br /> z <br />