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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 <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 />37 Accessory Structure (Garage, Shed, etc.) <br />$150 <br />I <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 <br />$125 <br />Bunkhouse <br />WI State Statute 59.692(ly) Structures <br />$250 <br />$350 <br />Filling/Grading <br />IS150 1 <br />lBoathouse <br />IS500 <br />I ISix Month Campine Unit (One Per Year) 15100 ■ IPermit Extension (lYear Extension - Allowed Once) 1$1001 <br />NOTE: After -the -fact permits (permit aquired after construction has begun) may cost up to three timesthe normal fee. I <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: pergoias, landscaping, etc. <br />Property Owner's Name:If f V <br />Property Owner's Mailing <br />Property Site <br />uttl' <br />aq(I f 4, (Zech tj1'/7h rylrI S—Pe <br />State Z&'c <br />Contact's Telephone Number:_ JE/I-t a- �"f' 2 v S --- <br />Contact's Email C r� e r 1 4!j 6) I -JA <br />Legal Description of Property: 0+0 <br />��� t � <br />Section #:�� Town #:- I _N Range #: LJ W Town of: �J iAC cS <br />*Attadi additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br />Tax I D # (1-5 digit number; found on tax slatement) _ -?7q <br />Proposed Use of Stnxtur A—_�_— <br />Anticipated Start Dane:_ (H-Wcabin; Carmercial Business; Bed Deck; etc.) <br />Building Contractor:_�� `'�C r' _ Sewer Installer: _ <br />AREA BELOW THIS LINE FOR LAND SERVICESSTAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS1SUBJECT <br />IITO ALL CONDITIONS LISTED BELOW: <br />N. I"\r\lyn <br />Date of staff site visit: <br />Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL' ' ''"""' DATE: <br />UPON APPROVAL: APPLICANT MUS POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Page 1 of 4 <br />Burnett County, W I Land Use Application — Rev 3fM18 <br />r <br />c <br />00 <br />P c - <br />I I <br />I <br />I <br />a � I <br />Z <br />LA) <br />l :7- <br />o <br />iv <br />I <br />I <br />�I I <br />I I <br />z <br />I <br />Fee Rec: l si 00 <br />V1A sa It <br />