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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 <br />Addition/Alteration to Dwelling/Principal Structure <br />Commercial/Industrial Structure $300 <br />Addition/Alteration to Commercial/Industrial Structure <br />Accessory Structure (Garage, Shed, etc.) $150 <br />Addition/Alteration to Accessory Structure <br />Accessory Structure (Commercial/Industrial) $200 <br />Addition/Alteration to Bunkhouse <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Driveways/ & Campground Structures $125 <br />Bunkhouse <br />WI State Statute 59.692(1v) Structures <br />d$500 <br />Filling/Grading $150 <br />Boathouse <br />Six Month Camping Unit (One Per Year) $100 <br />Permit Extension (1 Year Extension - Allowed Once) <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 />/� <br />Property Owner's Name: t ' di i' k � c k (o m <br />Property Owner's Mailing Address:_?13 <br />1-7— <br />Property Site Address: 30 l <br />wye y— <br />V it &LA 111' <br />City State Zip <br />r <br />Contact's Telephone Number: 7l <br />Contact's Email: 1'kGy C� • SCV1 obv► wL f i� J 4 tntiQc t V ln^ <br />Legal Description of Property: I- U T 8,4S5 L4 ICL Ass c,55 o R 5 r(CL+ <br />Section #:/I Town #:- 'LL—N Range #: W Town of: W I S <br />G <br />3 <br />P <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* T <br />Tax ID # (1-5 digit number; found on tax statement): <br />Proposed Use of Structure/Addition: OL&6j )4- j" u S C <br />Anticipated Start Date:_i4Nl F- _ 2,0 t $ (Home/Cabin; <br />Business; Bedroom; Deck; etc.) <br />Building Contractor: L ra !�FT E 13 a N C-, Sewer Installer: 1�r o tV S 0 KA <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: Initials of s' a 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 />z Fee Rec:�� <br />0 <br />n <br />N <br />0 <br />ib <br />