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LAND USE PERMIT APPLICATION — Burnett County, W1 <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate boxes) <br />a <br />J � <br />w <br />Dwelling/Principal Structure <br />$300 <br />Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure <br />$300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) <br />$150 <br />I <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) <br />$200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Driveways/ & Campground Structures <br />$125 <br />Bunkhouse <br />WI State Statute 59.692(1v) Structures <br />$35 <br />Filling/Grading <br />$150 <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />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 structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: Q 0- _ Q ti d W Ci wdt, -� 6 \ C1^ <br />Property Owner's Mailing Address: P-®C3� %G <br />Property Site Address <br />City State Zip <br />w, qA' j r. a,b w&r � U) StE 3 3 0 <br />Contact's Telephone Number: 7/S-- —72 j — 0) I <br />Contact's Email: IPS o ►\�r (D C 2 i $ a v,8 cc v, v, <br />Legal Description of Property: L O t I C S M# 3 Z'] 1 V 15 P 2 3 y f la C 3d 3Z - <br />Section #: Town #:N Range #:�W Town of: <br />*Attach additionalpage if neededfor lengthy description OR attach a copy of the deed OR attach tax systemproperty page.* <br />Tax ID # (1-5 digit number; found on tax statement): -!�- 13:7 .59. 6 (] I �_(I y <br />Proposed Use of Structure/Addition: S4mc1 .4v I a ^_-A % me rx'j"A rt i <br />Anticipated Start Date: – —_ (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor:S kaQeb_e aa. L A(AS" A AA Sewer Installer: <br />J <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS( PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />FO l 1 O,„/ 6-)) -s �or—)aYn� O v r r' <br />M 0,-X <br />6 ► a vn <br />N 3—co <br />Date of staff site visit: Initials of site visit staff. <br />4-1 <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL• DATE: Z� <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 />c <br />CZ– <br />�-q <br />C_. <br />r <br />N <br />5' <br />P <br />o' <br />a <br />J � <br />w <br />o <br />C7 <br />G <br />v <br />� <br />U� <br />Fee Rec: 3 <br />5 <br />s <br />