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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 $300 .tdition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/industrial Structure $300 (Addition/Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) $150 lition/Alteration to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) $200 L Addition/Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Bunkhouse $250 <br />WI State Statute 59.692(1v) Structures $350 <br />Driveways/ & Campground Structures $125 <br />Filling/Grading $150 <br />Boathouse $500 <br />Six Month camping Unit (One Per Year) $100 <br />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: perrgolas,laandscaping, etc. <br />���(� e �e-44et,l <br />Property Owner's Name: <br />Property Owner's Mailing Address: 7��� a? A <br />ity, State Zip <br />Property Site Address: OOa c4 M K.'u�.� f�,ri�r�.� �� • �tan�bu,`. , , f tTJ , -qgT o <br />P <br />c <br />Contact's Telephone Number: <br />�'TY"(r <br />Contact's Email: G} 5 moot -g t�w� <br />Legal Description of Property: <br />Section #: !o Town #: %0 N Range #: _W Town of <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): ( l <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: Sl(Sl 4 ---in; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: �r^� C:ortS�l� �- Sewer Installer: A)A!�- <br />SC&T -715--qle-o435- <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW <br />C, <br />COO <br />O� <br />coDate <br />of staff site visit: Initials of ite visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAU�1' 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 />COO <br />G <br />s� <br />171 <br />0 <br />�a <br />w <br />a <br />I I <br />350 � <br />y Fee Rec L <br />� <br />O <br />b <br />c_ <br />o <br />Ul <br />C <br />P <br />c <br />o <br />c <br />rD <br />a. <br />d <br />ao <br />COO <br />O� <br />d <br />Q <br />� <br />� <br />Q <br />z <br />z <br />w <br />I I <br />350 � <br />y Fee Rec L <br />