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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/I rid ustrial 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 1 lBoathouse $500 <br />Six Month Camping Unit (One Per Year) $100 1 1 Permit Extension (1 Year Extension - Allowed Once) 1$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: & r on r ? A r (-e tta Pr'e n c t <br />Property Owner's Mailing Address: 3 OU +-v,-r" <br />City State Zip <br />Property Site Address:_ 7 3 OC) N �.jJ4 h melte Rd1 1) a� t w S S Y £l 3 0 <br />Contact's Telephone Number: (o ! 2 r7Yl ' `1 `i g <br />Contact's Email: G e u r a e. R F r f N c H cP G +M a; o wA <br />Legal Description of Property: <br />Section #: Town #: N Range #: W Town of: <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): <br />Proposed Use of Structure/Addition: S 1-vro-g a - <br />Anticipated Start Date: ,'1'l ac, ) (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: S-& ( F ( I Sewer Installer: AJ a h <br />AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL JCONDITIONS LISTED BELOW: <br />/AI l 5����TUS J�� a/ �'c `►r't �erwi�s <br />r <br />V�Y-) <br />Date of staff site visit: Initials of site visit staff:" <br />PERMIT APPROVED BY ZONING OFFICIA &*—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 1/2018 <br />z <br />n <br />y <br />6- <br />r <br />C <br />b <br />0o <br />11 <br />:3 v <br />Uj <br />00 <br />Fee Rec:� <br />Cly- I q 0 is, <br />v <br />co <br />