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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 IrAddltion/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure tion/Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) tion/Alteration to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial)ition/Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk khouse $250Driveways/ & Campground Structures tate Statute 59.692(ly) Structures $350 <br />Filling/Grading house $500 <br />Six Month Camping Unit (One Per Year) mit Extension (1 Year Extension - Allowed Once) 1$100 <br />*NOTE: After -the -fact permits (permit aquired after construction has begun) may cost up to three times the normal fee. <br />*Communication Towers & Signs require a different application form, see corresponding application, and fees. <br />*Items not listed above will be treated as accessory structures, such as: pergolas, landscaping, etc. / <br />Property Owner's Name: 1 " 1 Q r <br />Property Owner's Mailing Address: —T I Ca l Pi- nn by <br />I City State *WU 11 <br />Property Site Address: q C- i t\ e f S IpoC3V-'1^ \A1 Z 5 q,�Vo <br />Contact's Telephone Number: 2-15 1 <br />Contact's Email: kA) P S+Q k6 j,.�n60Ce ('' e <br />Legal Description of Property: L. G k 2 1 Y' G ke Q B PG d, 50 j i U" .5 % 0 n <br />Section #:�� Town #: H 0 N Range #: I q W Town of: (�L eJ f+ <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br />Tax ID # (1-5 digit number; found on tax statement): I q 6 ~/ L <br />Proposed Use of Structure/Addition: "3()q+ 5 �6 rr 4 9 <br />Anticipated Start Date: Ina v 2 (J t Ej(Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: Md)2 "/yMa h Sewer Installer: Ny Y"(f <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />NV f— 6A <br />pm <br />Lowv)0,V-\ orc�e� ?ter �ia� 6`) 11l1/a0)$ <br />Date of staff site visit: Initials of site visit staff: <br />S- <br />PERMIT APPROVED BY LAND SERVICES OFFICIA"-.ek!!!��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 />C" <br />b <br />00 <br />—.0 <br />S <br />N_ <br />0 <br />b <br />N <br />UQ <br />� Fee Rec:' /50.00 <br />ry <br />O <br />co <br />