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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 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 />Property Owner's Mailing Address: i5 <br />City Stat Zip <br />Property Site Address:w.L <br />Contact's Telephone Number: <br />Contact's Email: h L�I� CC�iyif d�� <br />Legal Description of Property: Alf <br />Section #: /S Town #: 38' N Range #: /I/ W Town of: Q we N <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 �oo <br />Proposed Use of Structure/Addition: rd W) <br />Anticipated Start Date: (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: �a,,-fjy- Sewer Installer: N�W. <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TOI ALL CONDITIONS 1L_ISTED BELOW: <br />U 6,e. G--, l e�-S "i 9 3/ i O <br />APPROV P <br />Date of staff site visit: Initials of the visit staff: I <br />PERMIT APPROVED BY LAND SERVICES OFFICIA AWDATE:�� �I <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 3/2018 <br />Zb <br />r <br />W <br />C <br />a <br />Nm <br />J <br />d <br />lrrJ"�� <br />�o <br />o <br />z <br />o0 <br />�Sl <br />C� <br />a <br />o <br />< <br />t <br />V\ <br />w0 <br />lW <br />0 <br />N <br />0 <br />41 <br />0 <br />011 <br />w <br />8 <br />Fee Rec:S, '940 <br />W <br />C <br />a <br />Nm <br />J <br />z I <br />o r1 <br />�o <br />o <br />z <br />o0 <br />C� <br />