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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 NBunkhouse <br />/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure $300 /Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) $150 /Alteration to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) $200 /Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk se $250 <br />Driveways/ & Campground Structures $125 Statute 59.692(ly) Structures $350 <br />Filling/Grading $150 e $500 <br />Six Month Camping Unit (One Per Year) $100 xtension (1 Year Extension -Allowed Once) 1$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: ju,[ HHq ��'tGt�r!✓61iV <br />Property Owner's Mailing Address: Z% 195 Old 35wrb��ke VVI <br />City State Zip <br />Property Site Address: 5am� ei <br />Contact's Telephone Number: / 167- -577 - -r,�,69 <br />Contact's Email: Ql.(7f�Gj��� // �zw;w 'f <br />Legal Description of Property: A $� ,'SCG �dfiAl't %oo �rrw.,,�� ✓ <br />Z ,4 h Son>? <br />Section #: U tiTown #: 39N N Range #: I (pW Town of: e?i <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): 11572- <br />Proposed <br />1✓5" 72rProposed Use of Structure/Addition: 6-9V'Qfj _— <br />Anticipated Start Date::/ • I ' f (Nome/Cabin; Commercial Business; Bedroom: Deck; etc.) <br />Building Contractor: F�il�i ��� Sewer Installer: /V/t4 <br />AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />kvVIONtt <br />Date of staff site visit: 3 — 16L — /r Initi is of site visi taff: L�l <br />PERMIT APPROVED BY ZONING 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 />Fee Rec: <br />x <br />0 <br />N <br />O <br />C) <br />a) <br />a <br />T <br />17i <br />�0 <br />o <br />ON <br />O <br />V <br />a <br />z <br />2 <br />00 <br />m <br />p <br />m <br />