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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 Addition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) $150 Addition/Alteration to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(1v) Structures $350 <br />Filling/Grading $150 Boathouse $500 <br />Six Month Camping Unit (One Per Year) $100 Permit Extension (1 Year Extension -Allowed Once) $100 <br />*NOTE: After -the -fact permits (permit aqui red after construction has begun) may cost Uto 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: CJS e 4 yarlZ <br />Property Owner's Mailing Address: 3 1� � R b UQ -k {� L) -J4 0-13 <br />City State Zip <br />Property Site Address: �� 6 S GI• 11V �� <br />Contact's Telephone Number: <br />Contact's Email: Kou)J Zjrv*�t '-L�cp . gco <br />Legal Description of Property: L 1 r, W <br />Section #: 3 S Town 0 N Range #:�W Town of. 0—k I A" ok , <br />*Attach additional page if needed for lengthy description OR attttjach a copy of the deed OR attach tax system property page. <br />Tax ID # (1-5 digit number; found on tax statement):_ � / QJ 1 <br />Proposed Use of Struct e/ tion: _S, X 7 �lrt- <br />Anticipated Start Date: (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: 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 />Date of staff site visit: Initials of site visit staff: C, <br />& A— <br />PERMIT APPROVED BY ZONING OFFICIALDATE:3 + az �I a <br />UPON APPROVAL: APPLICA(Ni 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 />Cn <br />c <br />Q <br />a <br />0 <br />0 <br />w <br />N <br />R. <br />0 <br />N <br />n <br />t'' <br />b <br />75 <br />LA <br />I \' <br />8 <br />C <br />J U <br />Fee Rec: <br />519 <br />E5 <br />N <br />0 <br />z <br />n <br />H <br />71 <br />6A fl <br />z ON til <br />-1 <br />n <br />z- <br />a <br />MG)o <br />f <br /></!/! <br />co <br />rV <br />Q <br />o I <br />b � <br />M <br />a <br />m <br />