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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 />i� eck/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 $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. l <br />3 J�Rlli �pL6f�� C�74-�-7 <br />PropertyOwner's Name: <br />Property Owner's Mailing Address: v70 Jr ,7 /0-4 fives AIKI CaUJ ABbS ,MA/ SY5'33 <br />q n City State Zip <br />Property Site Address: 3 / 7 7 04toj 1-k lel Uz f)"y <br />Contact's Telephone Number: 7/6 _ SLPIo / / 7 3 <br />Contact's Email: J �ieoiT��%�/�lg/1 fpM <br />Legal Description of Property: PCZ 4 oV 407-.7- 71%--T -/+ 5- <br />Section <br />Section #:/- Town #:7- -'1fA1 N Range #:15W Town of: 5A)% SS <br />*Attach additionalpage if neededfor 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): oZ / 3 3 5- <br />Proposed <br />Proposed Use of Structure/Addition: %3�D ROvN(� ��C �(T�N Slog►/ f'jFMOc�FL <br />Anticipated Start Date: F% $ .%i i (Home/Cabin: Commercial Business: Bedroom; Deck; etc.) <br />Building Contractor: �i!9/11 �/f'aT Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW- <br />6'e, <br />ELOW:6e, �-r o a,r, (Y>', rr� m awt MWMW <br />q <br />Date of staff site visit: / Initials of ite visit staff- <br />PERMIT APPROVED BY LAND SERVICES 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 3/2018 <br />c <br />0. <br />O <br />e <br />N <br />a <br />d <br />s <br />0 <br />n <br />l <br />b <br />I� <br />O <br />F <br />0 <br />b <br />as <br />o w <br />x <br />l lj � C7 <br />V) ly <br />Fee Rec: nn t)o r <br />