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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/Alter 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(ly) Structures $350 <br />Filling/Grading $150 Boathouse $SW <br />Six Month Camping Unit (One Per Year) $100 Permit Extension (1 Year Extension - Allowed Once) Isloo <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 />11 tt t <br />Property Owner's NameC Q A l! k as co � <br />Property Owner's Mailing Address: 54, [i 1 A br 6 <br />City State Zip 5 $ <br />Property Site Address: t - <br />Contact's Telephone Number:_ell ('0 r)) 1 1319 <br />��,,+ IGs!3p-3-V-!S- rLaII �,aL"tic) <br />Contact's Email: r r 1 C l 2 n �ail <br />C , c CJS <br />Legal Description of Property: ` V G Vida6e L G f 4;a <br />Section #: I () Town #: 14'v N Range #:W Town 01 : r <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): v V1 ! jZ rk<��� I q <br />W., U �1 <br />Proposed Use of Structure/Addition: rzt IYI L L C <br />Anticipated Start Date:aAA �c�' (Home/Cabin; Commerc' 1 Business; Bedroom;ck; etc.) <br />Building Contractor:f' Sewer Installer: �; f A" <br />�;-7 <br />AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Cry X `s ✓n u v� 0� (S e a_ <br />�\/vim <br />Date of staff site visit: -------' Initials of site visit staff: <br />PRUMiT APPD"vvn tiv 7nNjiNjc- nvTiiciAi.• LA, nATF.•S f LII <br />- IS <br />UPON APPROVAL: APPLICAN 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 />0 <br />1 <br />r <br />w <br />o. <br />Y <br />�/ <br />1~'Q <br />• <br />to <br />.y�. <br />V <br />� <br />p' <br />n <br />CA <br />_ <br />1 <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure $300 Addition/Alter 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(ly) Structures $350 <br />Filling/Grading $150 Boathouse $SW <br />Six Month Camping Unit (One Per Year) $100 Permit Extension (1 Year Extension - Allowed Once) Isloo <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 />11 tt t <br />Property Owner's NameC Q A l! k as co � <br />Property Owner's Mailing Address: 54, [i 1 A br 6 <br />City State Zip 5 $ <br />Property Site Address: t - <br />Contact's Telephone Number:_ell ('0 r)) 1 1319 <br />��,,+ IGs!3p-3-V-!S- rLaII �,aL"tic) <br />Contact's Email: r r 1 C l 2 n �ail <br />C , c CJS <br />Legal Description of Property: ` V G Vida6e L G f 4;a <br />Section #: I () Town #: 14'v N Range #:W Town 01 : r <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): v V1 ! jZ rk<��� I q <br />W., U �1 <br />Proposed Use of Structure/Addition: rzt IYI L L C <br />Anticipated Start Date:aAA �c�' (Home/Cabin; Commerc' 1 Business; Bedroom;ck; etc.) <br />Building Contractor:f' Sewer Installer: �; f A" <br />�;-7 <br />AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Cry X `s ✓n u v� 0� (S e a_ <br />�\/vim <br />Date of staff site visit: -------' Initials of site visit staff: <br />PRUMiT APPD"vvn tiv 7nNjiNjc- nvTiiciAi.• LA, nATF.•S f LII <br />- IS <br />UPON APPROVAL: APPLICAN 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 />0 <br />1 <br />w <br />o. <br />� <br />p' <br />n <br />CA <br />_ <br />0 <br />d <br />7 <br />� <br />00 <br />d <br />4 <br />n' <br />G <br />� <br />x <br />y <br />� <br />0 <br />z <br />S <br />z <br />0 <br />Fee Rec'� <br />I <br />Cash �,T <br />