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LAND USE PERMIT APPLICATION — Burnett County, WI g <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure $300Addition/Alteration <br />to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure $300rjWl <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) $150Addition/Alteration <br />to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) $200Addition/Alteration <br />to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Driveways/ & Campground Structures $125 <br />Bunkhouse <br />State Statute 59.692(ly) Structures <br />$250 <br />$350 <br />filling/Grading $150 1 <br />lBoathouse <br />$500 <br />Six Month Camping Unit (One Per Year) $100 1 <br />1 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 be treated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: 6A rel W, -6k4, 6orhrm `I' /' onJ ,. l d b0( ff7 <br />Property Owner's Mailing Address: ?,-10 D <br />Property Site Address: 4 Z VAIN <br />Contact's Telephone Number: 3�Q 7q5 Le O& 5 <br />Contact's Email: 6 6, Cc ) qJ G? J—Lt L (.0 1 <br />. Ca'r <br />11, <br />City State <br />0,10 <br />Legal Description of Property: Loo 1 1 ),, ,-6 4; � � � jj-.21n 'lyyo44 4e/ �/,' � <br />Section #: Town #: N Range #: W Town of:��A <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): <br />Proposed Use of Structure/Ad <br />Anticipated Start Date:�t <br />Building Contractor: <br />Commercial Business; Bedroom; Deck; etc.) <br />Sewer Installer: <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />a0 �Dc;sr.:v9 P r�� for y Seaso.vs <br />G <br />�n <br />a <br />0 <br />[m <br />n1 <br />Date of staff site visit: 3 S O Initials o site isit staff: <br />PERMIT APPROVED BY ZONING OFFICIAL: ^ DATE: <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />M. Page 1 of 4 <br />APPROVE Burnett County, WI Land Use Application — Rev 1/2018 <br />C" <br />b <br />00 <br />—0 <br />i <br />NO <br />i <br />Fee Rec-j-0c) <br />y <br />d <br />a <br />C <br />o <br />V <br />� <br />S <br />NLY <br />z <br />to <br />n1 <br />Date of staff site visit: 3 S O Initials o site isit staff: <br />PERMIT APPROVED BY ZONING OFFICIAL: ^ DATE: <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />M. Page 1 of 4 <br />APPROVE Burnett County, WI Land Use Application — Rev 1/2018 <br />C" <br />b <br />00 <br />—0 <br />i <br />NO <br />i <br />Fee Rec-j-0c) <br />y <br />d <br />a <br />C <br />o <br />