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LAND USE PERMIT APPLICATION — Burnett County, WI <br />Applicant Complete All Sections Below This Line 15. <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure $300 <br />Commercial/Industrial Structure $300 <br />Accessory Structure (Garage, Shed, etc.) $150 <br />Accessory Structure (Commercial/Industrial) $200 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Driveways/ & Campground Structures $125 <br />Filling/Grading $150 <br />Six Month Camping Unit (One Per Year) $i00 <br />Addition/Alteration to Dwelling/Principal Structure <br />Addition/Alteration to Commercial/Industrial Structure <br />Addition/Alteration to Accessory Structure <br />Addition/Alteration to Bunkhouse <br />Bunkhouse <br />W1 State Statute 59.692(1v) Structures <br />Boathouse <br />Permit Extension (1 Year Extension - Allowed Once) <br />$200 rC <br />$200 <br />$150 <br />$150 <br />$250 <br />$350 <br />$500 ju <br />$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 <br />�as�accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name:" 1/1/(ZpLe.- t � <br />Property Owner's Mailing Address: $ <br />Q ' / Cit tate Zip <br />Property Site Address:9q-7q f, &&5 b^ NdIP4 W{6'f or tN ( s a <br />Contact's Telephone Number: 119 7 11-2L <br />Y <br />Contact's Email: <br />Legal Description of Property: �A 1 I V' i S li &e <br />Section #: � q Town #: 2)j N Range #: W Town of: (y) -e R it © ►'N <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br />2 � <br />Tax ID # (1-5 digit number; found on tax statement): <br />Proposed Use of Structure/Addition: S'% r �� `� — C,ar ��-a- ��fyc.�►�� <br />Anticipated Start Date: fn Cl- V4 <br />Building Contractor: <br />Business; Bedroom; Deck; etc.) <br />Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />IrrPROVED <br />Date of staff site visit: Initials o site vW�:-- <br />PERMIT <br />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 />Burnett County, WI Land Use Application — Rev 3/2018 <br />s <br />d' <br />m <br />Fee Rec: + 00 <br />�A� <br />a <br />N <br />O <br />Co <br />