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LAND USE PERMIT APPLICATION — Burnett County, WI C r <br /> K � <br /> a � b <br /> Applicant Complete All Sections Below This Line ' <br /> Permit Types and Fees:(Please,check appropriate boxes) d <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 /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 <br /> Accesso S r cture Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk `7 >_ Bunkhouse $250 ° <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 <br /> $i50 Boathouse $500 d <br /> Six Month Camping Unit(One PerYear) $100 Permit Extension(1 Year Extension-Allowed Once) $100 v <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. �. <br /> o ' <br /> Property Owner's Name:. � <br /> Property Owner's Mailing Address: 716,5 ( Ck A 1_V' AW4 5: y <br /> _ City State Zip <br /> Property Site Address: I�j' % '� l��,,�J Lo C <br /> Contact's Telephone Number: 0. <br /> 0 <br /> Contact's Email: <br /> Legal Description of Property: _ LO�" n1 V 6 C/O �,�iV 6o j 1-5 J ) o � <br /> Section#: Town#:-, N Range#: /(a W Town of: MCC/()00 <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: Der;L -4- <br /> Anticipated Start Date:p M/-�-V 15 'Ar)"24-, (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C7 <br /> Building Contractor: Sewer Installer: /Upf1/C, <br /> AREA BELOW TAIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> z .p <br /> = Fee Rec:��/�� y' <br /> Date of staff site visit: / I Wals of site visit staff: <br /> APPROVED BY LAND SERVICES OFFICI DATE: <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF 0 <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 3 K <br /> Transcendent: - Page 1 of 4 <br /> Laserfische: - Burnett County,WI Land Use Application—Rev 1/2019 <br /> m <br /> C <br /> -i <br /> a <br />