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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 Addition/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 Addition/Alteration to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(1v) Structures $350 <br />Filling/Grading $150 Boathouse I $500 <br />Six Month Camping Unit (One Per Year) $100 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: pergolas, landscaping, etc. <br />Property Owner's Name: c I L s4 i ;�. r n t.-J� <br />Property Owner's Mailing Address: © lam S t h , ` "� a; .4 i ISS <br />City State Zip <br />Property Site Address: _ r' fi k tt. <br />Contact's Telephone Number: <br />`} SS aD�p <br />Contact's Email: L L= r i 4:5 4 N Ao Lo <br />Legal Description of Property: LA" AQ-r—e 1� 16 i A', a tJ io UL I i ( %V�l A K.- (o6 t• <br />Section #: S 2A Town #:__Yo N Range W Town of: 0-1 K 1441 d <br />*Attach additionalpage 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): �' `� i / 2— <br />Proposed <br />Proposed Use of Structure/Add'tion: St`c r ra c e-, <br />Anticipated Start Date: r" 4% (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: Sewer Installer: <br />AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />v s4 Nw. . o -F <br />7d9g p p <br />Date of staff site visit: o _J o Initials of site visit staff: `S� <br />PERMIT APPROVED BY ZONING OFFICIAL DATE: <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Page I of 4 <br />Burnett County, WI Land Use Application — Rev 1/2018 <br />b <br />t•' <br />ro <br />00 <br />Oft <br />O <br />9� <br />r <br />tA <br />Q <br />i <br />ti <br />S <br />I <br />77 <br />Fee Rec: �. <br />d <br />m <br />