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,1� <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 $300;Addition/Alteration <br />on/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure $300 to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) $150on/Alteration to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) $200on/Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk ouse $250 <br />Driveways/ & Campground Structures $125te Statute 59.692(ly) Structures $350 <br />Filling/Grading $150 1 lBoathouse $500 <br />Six Month Camping Unit (One Per Year) $100 1 jPermit 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: Cj � 4e, r\ SL4 `i530 <br />Property Owner's Mailing Address: U3 u 5 n bVr W -;-- <br />Y T City State Zip <br />Property Site Address:_ 303 � B {�lJ� flc�.x�)p� : 4 , ��. 641es 3 a,(A - I- k <br />Contact's Telephone Number: //��(P `i - 3 O <br />Contact's Email: Az- 6Y <br />Legal Description of Property: IA C -J K -T ;2A 3 A <br />Section #:Al Town #: kT N Range #: 16 W Town of: luje6l is �w ;S <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):, ?� 0 co, 5" <br />Proposed Use of Structure/A diti n: C e '` <br />Anticipated Start Date: (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Sk@.ti <br />Building Contractor: 54- d kh ",ub c:'� Sewer Installer: <br />AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />.11pp <br />Y� <br />40 4,oPPROVED <br />rear �� ,I tiv�2 <br />Date of staff site visit: 3 Ini as of sit isit staff: <br />PERMIT APPROVED BY ZONING OFFICI DATE: <br />UPON APPROVAL: APPLICANT 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 />G <br />0. <br />O� <br />C <br />� <br />i <br />03 <br />ITI <br />0 <br />0 <br />a <br />w <br />5 <br />0 <br />a <br />5' <br />0 <br />d <br />Y� <br />W <br />O <br />00 <br />un <br />Fee Rec: 1 S 0 <br />z <br />Rel <br />D <br />o <br />d <br />N ,; <br />4Z <br />00 <br />m <br />m <br />