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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 $300rAddition/Alte <br />on/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure $300on/Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) $150ration 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(1v) Structures $350 <br />Filling/Grading $150ouse $500 <br />Six 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 o 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 />/ <br />Property Owner's Name: ct�- i C A / ! , k we, / <br />Property Owner's Mailing Address: ?03SI ,��r.� A-) w n, 5c -e,) ✓ %2— <br />�q <br />r , City ate Zip <br />Property Site Address: 763s_ Sttr,, �/� �(� t �y' W�1 <br />Contact's Telephone Number: r �71,r� D56 (-13'3 q <br />Contact's Email:: C.,� c eg Iy - �d • n �� <br />Legal Description of Property: pc/ r e 0701 P 2-j a icy <br />n n <br />Section #: Town #:_n_N Range #: i6 W Town of: � e {� O <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: C '7qi e.t' 9 �d e <br />Anticipated Start Date: A& S (Home/Cabin; Commercial Businress,-, Bedroom; Det ; etcJ <br />Building Contractor: W -r-' ,/liak'L,-P- Sewer Installer: W tC�Qi RVf-1, <br />AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Date of staff site visit: lnitialyqf site vi it sta <br />PERMIT APPROVED BY ZONING 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 1/2018 <br />0 <br />r <br />0 <br />i <br />0 <br />7 <br />5" <br />ro <br />d <br />�1 <br />-a <br />y <br />a <br />e <br />CDO <br />OQ <br />w <br />a <br />w <br />z <br />0 <br />JQ <br />c'C <br />a <br />e <br />VA <br />0 <br />S <br />Fee Rec: - " <br />r <br />b <br />00 <br />.T <br />X <br />0 <br />W <br />V) <br />