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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 />� <br />� <br />r <br />b <br />Dwelling/Principal Structure $300 <br />Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure $300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) $150 <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) $200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Driveways/ & Campground Structures $125 <br />Bunkhouse <br />WI State Statute 59.692(ly) Structures <br />$250 <br />$350 <br />Filling/Grading $150 <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) $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: C, r <br />Property Owner's Mailing Address: <br />Property Site Address: Ss;,A� <br />City State Zip <br />Contact's Telephone Number: ©VA— ��S' ` " /gni r✓r:. �rS S'��� ' � / <br />Contact's Email: <br />Legal Description of Property: rV E - ZT ` Ex 'V 3,?c � L <br />Section #:_Z; Town #: �(:` N Range #: _W Town of: �'A ZA''VO <br />*Attach additional page if neededfor 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): % 71V <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: <br />(Home/Cabin; Commercial Business,- <br />Building <br />usiness; <br />Building Contractor: C*Cc�7 mkt .% r���- Sewer Installer: 6/1ri4 <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />APPROVED <br />Date of staff site visit: Initials of site visit staff - <br />1 <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE:`4 "g <br />UPON APPROVAL: APPLICANT ST 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 />� <br />- <br />� <br />� <br />r <br />b <br />N <br />c <br />a <br />d <br />r <br />o0 <br />Vn <br />V ' <br />V` <br />S <br />� <br />O <br />o <br />� <br />r, <br />o <br />OG <br />—' <br />� <br />m <br />G <br />-o <br />n <br />� <br />o <br />Q, <br />� <br />Q <br />C <br />(n <br />c <br />CD. <br />C7 <br />� <br />c ao <br />� <br />d <br />T <br />� <br />x <br />S <br />O�©0rS <br />Fee Rec� <br />C <br />rn <br />a <br />r <br />