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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 />� <br />Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) $150 Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) $200 Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse <br />$250 <br />Driveways/ & Campground Structures WI State Statute 59.692(1v) Structures <br />$350 <br />j$125 <br />Filling/Grading $150 Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) $100 Permit Extension (1 Year Extension - Allowed Once) <br />$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 beettr1eated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: ✓ I'1awh J Vt 6.. v,, <br />n, <br />Property \,"t e,n (,v- NN�� 11r / V E 6$005 <br />Owner's Mailing Address: Vve-. . <br />// D t City State Zip <br />'3101 <br />Property Site Address: V 'Of rn o:.y1 � � Q,,y�byf �/ <br />( <br />Contact's Telephone Number: 1 i 6 35,30 <br />Contact's Email: 5 S \,l 6" ks Le0n54f'vC.� <br />Legal Description of Property: H G,SM V (� g <br />Section #: 12 Town #: � d N Range #:) 6 W Town of: C 1 O Y, �/ <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br />Tax ID # (1-5 digit number; found on tax statement): 13 37 LI <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: ' <br />p ►1(1 (Ho`�ie/Cabin: Commercial Business; Bedroom; Deck; etc.) <br />q Q <br />Building Contractor:` -P- 6-r k WOE Sewer Installer: <br />ARRA RFT nW Ti7ic�I TT1wr Ti CLD\7L`T L`dI-X" ll XT—Ti <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Date of staff site visit: I 'tials of site visit staff. <br />PERMIT APPROVED BY ZONING OFFICIA DATE:" a r <br />N APPROVAL: APPLICANT MUST POST ( <br />OPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Page 1 of 4 <br />Burnett County, WI Land Use Application — Rev 1/2018 <br />.1j <br />Q <br />3 <br />� <br />� <br />x <br />C�LAI° <br />d <br />w <br />Q <br />� <br />z <br />� <br />Fee Re�� <br />, �b <br />