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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 <br />$200 <br />Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) $150 Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) $200 Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(1v) Structures <br />$250 <br />$350 <br />Filling/Grading $150 Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) $100 Permit Extension (1 Year Extension - Allowed Once) <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 as accessory <br />structures, such as: pergolas, landscaping, etc <br />Property Owner's Name:��� <br />Propert <br />y Owner's Mailing Address: �•� � �L�� �� '� `� <br />City State Zip <br />Propert <br />y Site <br />Contact's Telephone Number: _Inq96 ' �I? n/13�,,1� <br />Contact's Email4f/� c 3,-)o <br />���''!/7L�v• �-�% <br />Legal Description of Property: SE /T/S39-�1o'3a,/'/� D�/-DL0—O//O©/ <br />ol <br />Section #: 3Town #: 39 <br />N Range #:�� Town of: /�/,�Bi✓dit/ <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): 3a 31 <br />i <br />Proposed Use of Structure/Addition: '1 tiOx1 o -r ) l <br />Anticipated Start Date: o, T' (Home/Cabin: Commercial Busine�ss��Bedroom: ck; etc.) <br />Building Contractor - Sewer Installer: /� � , .' <br />. <br />�_ <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />/v0Y` 70 /JQ (/Sdp( -j'Or 07a0✓ el11�4.1`ion/, <br />44,61d,ror /d X J 44'1.av o yANqx <br />z X19 <br />Date of staff site visit: J X02 & - % Lsr <br />Initials of site isit staff: <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 />Burnett County, WI Land Use Application —Rev 3/2018 <br />N <br />Cm <br />UP <br />n' <br />~� r <br />� rD <br />NZ <br />n <br />� <br />m <br />Zn <br />c� o <br />o 0 <br />o <br />ao <br />