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LAND USE PERMIT APPLICATION — Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (urease, check appropriate boxes) <br />Dwelling/Principal Structure $300rAddition/Alteration <br />on/Alteration to Dwelling/Principal Structure $200 <br />Commercial/industrial Structure $300on/Alteration to Commercial/Industrial Structure $200 <br />X Accessory Structure rage Shed, etc.) $150 to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) $200on/Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk ouse $250 <br />Driveways/ & Campground Structures $125te Statute 59.692(iv) Structures $350 <br />Filling/Grading $150ouse $500Six Month Camping Unit (One Per Year) $100t 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 fisted above will be treated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: S '� )C41 ¢ S 0x. n- O <br />Property Owner's Mailing Address: N-71 'O St / t��`t�L�C� w i 7 �i <br />CiState Zip <br />Property Site Address: 3 <br />Contact's Telephone Number: v5 L4 q ,J - 7 1 a a <br />Contact's Email: S`O►G� D�C' lc)tyf. n� j <br />Legal Description of Property- 1 -.Cf i CSM Ff15S f V� P 13 ] ( 60 V i0 f 5) frd,34& q4 <br />Section #:_ Town #:N Range #: 1 W Town of: d GIC IC,S )YI <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):) 5561A <br />Proposed Use of Structure/A d'tion: Ga-� <br />Anticipated Start Date:_ <br />L91114 (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: ttsnS f-�q,, etl Ui-) (L- Sewer Installer: N /P <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDIITIONS LISTED BELOW: <br />_ <br />SST aC-�S US2 Ca�%Ti <br />Date of staff site visit: Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL 92L 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 />