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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 d$300 <br />Addition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure Addition/Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) Addition/Alteration to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) Addition/Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(ly) 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: �Tygti emAvr <br />Property Owner's Mailing Address: © "5174 <br />City State Zip <br />Property Site Address: <br />Contact's Telephone Number: 0 2-9Z a i T <br />Contact's Email: <br />Legal Description of Property: r Gtr( S'�'%? ��'�/`�' GQias. % <br />Section #:2-7 Town #: _N Range #: W Town of. e ,<4�,V6 <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): <br />Proposed Use of Structure/Addition: Ok?G,Ot <br />Anticipated Start Date: 5--1 — (o(Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: SpG t= 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 />Date of staff site visit: Initials of 'te visit 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 />z <br />0 <br />a <br />z <br />0 <br />Fee Rec:1 5� <br />-1:1— J <br />r <br />Cr <br />< <br />- <br />b <br />O <br />9� <br />d <br />O <br />o <br />a <br />P <br />0 <br />r <br />G <br />° <br />cn <br />9- <br />0 G <br />^o <br />o <br />'-t <br />- <br />z <br />0 <br />0 <br />0 <br />E. <br />Cn <br />o <br />d <br />z <br />0 <br />a <br />z <br />0 <br />Fee Rec:1 5� <br />-1:1— J <br />