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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 b ) <br />X 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 jWl State Statute 59.692(ly) Structures $350 <br />Filling/Grading $150 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: -� A-�: L � —1K u'S r <br />Property Owner's Mailing Address: 343,f- b Q , WL`TS TX -4? W "773 <br />City State Zip <br />Property Site Address: -- 0 -17-+e" 17PSSCl -0 R D , Wcz-73 S rzFlz lea ( S -'4-'i T3 <br />Contact's Telephone Number: I5 - 5 -IC G- - ,I <br />Contact's Email: S f e r C rn q i ^ C' 0 M <br />Legal Description of Property: <br />Section #: 1> 0 Town #: V 0 N Range #: k W Town of: �3 Cc9 7� <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): 3 3 '5 3 (r, <br />Proposed Use of Structure/Addition: hjD� (�- <br />Anticipated Start Date: Ar P R l 1, Y-0 1 P (Home/Cabin; Commercial Business: Bedroom: Deck: etc) <br />Building Contractor: ! 'TEVC 5 V(C- NY Sewer Installer: +VO f Ki11`1(� <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />4fd 69 Kej �Pr �`ol` &a A,, We 11,'5.1 <br />Date of staff site visit + Initials of sit v' it staff <br />LIP <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: ' <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Page 1 of 4 <br />APPROVfDBurnett County, WI Land Use Application — Rev 3/2018 <br />c. <br />o' <br />0 <br />0 <br />a <br />a <br />5 <br />N <br />`s <br />5' <br />b <br />00 <br />X) <br />O <br />M <br />V, <br />r <br />i C) d <br />z <br />--i Fee R!300 <br />00 <br />