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LAND USE PERMIT APPLICATION — Burnett County, WI <br />s. <br />Applicant Complete All Sections Below This Line $ <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure $300 / <br />Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure $300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) $150 <br />to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) $200 <br />on/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />X Driveways/ & Campground Structures $125 <br />tAddon/Alteration <br />ouse <br />te Statute 59.692(1v) Structures <br />$250 <br />$350 <br />Filling/Grading $150 <br />ouse <br />$500 <br />Six Month Camping Unit (One Per Year) $100 <br />t 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: <br />19,1"d v M "g, <br />Property Owner's MailingAddress: / 3 a 3 <br />Property Site Address: 0 / 9d, -5/,t 7? <br />r,/ A" 5 f )!9a" / R o <br />JU 762, City State Zip <br />Contact's Telephone Number: t Tl ` 3 a y—DU%S <br />Contact's Email: djq`I �eKS (f 0&,//00k-, Com <br />Legal Description of Property: SPP q A C P - lrf (/IIP L n <br />Section #: 3 S Town #: 3 i N Range #: / G W Town o : /I%C�PV2 0CI <br />*Attach additionalpage 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): <br />Proposed Use of Structure/Addition: 01-c '/+ <br />Anticipated Start Date: 3 b / • ommercial Business; Bedrol m; Deck; etc.) <br />Building Contractor: APFKUVbVr Installer: <br />jr M0 an <br />AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />.� <br />I � <br />-0 j o) :5 (=,� a` SAL. 6,-,X <br />Date of staff site visit:I itials of site visit staff: S D15 <br />PERMIT APPROVED BY ZONING OFFICIA DATE: <br />UPON APPROVAL: APPLICA MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Page 1 of 4 <br />Burnett County, WI Land Use Application — Rev 1/2018 <br />Z <br />r <br />N <br />0 <br />5� <br />d <br />Fee Rec <br />,�- 5.1313 <br />w <br />C <br />70 <br />� r <br />m <br />0mCID <br />z <br />^' r <br />Qo <br />o <br />_ < <br />�- 4 <br />1313 <br />