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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 iBoathouse $500 <br />Six Month Camping Unit (One Per Year) $100 1 jPermit 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 />� I � <br />Property Owner's Name: r lyre, l d C <br />Property Owner's Mailing Address: (� �5,v Wi 4 <br />jCity State Zip <br />Property Site Address: �l %� % %%1 f?��yi �� i1 0/1'�.� /( —C /V Iy � <br />Contact's Telephone Number:_ 6, /1 -- 3 2- -7 70 <br />Contact's Email: t T i /(f w) wW .) /� V , 6� 014 <br />Legal Description of Property: <br />Section #:Ji,�_ Town #:�_ 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):�•Z- <br />Proposed Use of Structur=io : i � 11�/ F, 1,7 L"�1,/J '9 V�� — / .0 ter! , i — v <br />Anticipated Start Date: (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: 11,�(jNG%l/�, 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 />Date of staff site visit: ~ �3 Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIA . 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 />