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Ar - <br />C <br />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 ]$150 <br />Addition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure Addition/Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) Addition/Alteration to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) Addition/Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br />Driveways/ & Campground Structures WIState Statute 59.692(1v) Structures $350 <br />Filling/Grading Boathouse $500 <br />Six Month Camping Unit (One Per Year) 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. <br />Property Owner's Name: t " Ci <br />Property Owner's Mailing Address: ,l h <br />Q ICl <br />State <br />,Property Site Address: Z-2 7 a <br />Contact's Telephone Number: I �/ �I ` 3 <br />Contact's Email: S p jy I• y./l �12 i fj s ® lel /• (76j+1 <br />Legal Description of Property: kci A/4) <br />Section #:� Town #:_V ON Range #: I W Town of: <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tc system property page.* <br />Tax ID # (1-5 digit number; found on tax statement):j6 <br />Proposed Use of Structure/Addition: PC, en <br />Anticipated Start Date: L)-2 b - 1 f (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: Sewer Installer:_ `U 'e— <br />AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />/V\ <br />Z\ 1 v� n <br />Date of staff si it Ir M Initials of site visit staff: <br />It 16 V <br />PERMIT APR "OFFICIAL: DATE: <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Page I of 4 <br />Burnett County, WI Land Use Application — Rev 1/2018 <br />a <br />a <br />m <br />c <br />a <br />73 <br />N <br />0 <br />0 <br />d <br />m <br />N <br />0 <br />z <br />n <br />> <br />a <br />r <br />z <br />M <br />W <br />�QN <br />C==m <br />o <br />M— <br />o <br />a <br />� <br />Z <br />On <br />Qb <br />m <br />A <br />M <br />