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LAND USE PERMIT APPLICATION - Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate boxes) <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 />Accessory Structure (Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(1v) Structures $350 <br />Filling/Grading $150 Boathouse $500 <br />Six Month Camping Unit (One Per Year) $100 1 jPermit 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.,, <br />Property Owner's Name: ��� 4 ,;t 'E / 4 --e1 7ei <br />Property Owner's Mailing Address: " <br />City State Zip <br />Property Site Address: Ate'►-f�Q <br />Contact's Telephone Number: --7 <br />Contact's Email: / // <br />Legal Description of Property: Zo l / fS/Y1 V A0 /' /� <br />y7 <br />Section #: Z9 Town #: 4 O N Range #: /.S W Town of: ,1aL Sem <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): sg 3 <br />Proposed Use of Structure/Addition: Va.1r0,Q '- <br />Anticipated Start Date: a'S—j7 (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: Se41r Sewer Installer: <br />AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />ax S i S� 3 j s� 6 t ��" <br />Cc V"I <br />Date of staff site visit: �— Initials of site visit staff: <br />PERMIT APPROVED BY ZONING OFFICIAL: DATE: <br />UPON APPROVAL: APPLICANT UST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Page 1 of 4 <br />Burnett County, WI Land Use Application — Rev 12/2017 <br />In <br />0 <br />0 <br />a <br />a <br />N <br />0 <br />5' <br />0 <br />t <br />CJ <br />C <br />a <br />y <br />x <br />d <br />Fee Rec: %r0 D0 <br />0 <br />m <br />N <br />O <br />C <br />> C, <br />m <br />i <br />'IN Z <br />(") <br />Az <br />0 <br />� <br />� <br />C== <br />O <br />C: <br />N <br />c <br />m <br />0 <br />`V <br />M <br />a <br />m <br />z <br />m <br />