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r <br /> LAND USE PERMIT APPLICATION —Burnett County, WI a 1 b <br /> Applicant Complete All Sections Below This Line 0 o <br /> a. <br /> p <br /> Permit Types and Fees:(Please,check appropriate boxes) d On <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 /> v Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 ;i <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br /> G) �1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 $) <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 r• <br /> 0 <br /> Filling/Grading $150 Boathouse $500 i <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 o. <br /> `� <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. n I. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> ` r g <br /> o <br /> 4- <br /> PropertyOwner's Name: B ) 'v"ll6FY-cemaaJ ° <br /> ,T1 <br /> `, ' r <br /> ' R ..5 10 L.-o r d L R)/201‘_ _ WQJ� U.S 51Y-3° a <br /> Property Owner's Mailing Address: <br /> City State Zip F. <br /> Property Site Address: E <br /> • c <br /> Contact's Telephone Number: 7/ –2 33-- 63/� a <br /> d <br /> Contact's Email: 1 ¢kt n-1 U 9O5 /i O-� . corn <br /> Legal Description of Property: o0 <br /> Section#: CAR Town#: V 0 N Range#: ) �L,Town of: SC_c1 ao <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> 0 <br /> Tax ID#(1-5 digit number;found on tax statement): 1729 V <br /> Proposed Use of Structure/Addition: <br /> S+wC.J <br /> Anticipated Start Date: in AA. at, (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) t7 <br /> Building Contractor: 01 PAry Sewer Installer: N//T .—t <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY `� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELO : `i <br /> a. '*-om d x <br /> i.• <br /> No* FD fz N-�.� <br /> Fee Rec: /5Q <br /> Check#: 9 k <br /> 0 <br /> Date of staff site visit: I In 4 iv Initia f site visit staff: likkl --- <br /> rm <br /> BY LAND SERVICES OFFICIAL: DATE: • 0 Tri <br /> 1-7------ <br /> APPROVED Q_ <br /> UPON APPROVAL: APPLICANT MUST POST OPY OF ,Z;.,SIGNED PERMIT APPLICATION IN PLAIN SIGHT Transcendent: - Page 1 of 4 a ru oLaserfische: - Burnett County,WI Land Use Application—Rev 1/2020 a Q NIB <br />