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LAND USE PERMIT APPLICATION — Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />a <br />H <br />Pe Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Pripcipal 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(iv) Structures $350 <br />Mi"x"Month <br />in Gradin $150 Boathouse $500 Camping Unit (One Per Year) $100 jPermit Extension (1 Year Extension - Allowed Once) Isloo <br />*NOTE: After -the -fact permits (permit aquired after construction has begun) may cost up to three times the normal fee. <br />*Communication Towers & Signs require a different application form; see corresponding application, and fees. <br />*Items not listed above will be treated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: 1 - i;'�'U o�, and c , L.,L C <br />Property Owner's Mailing Address: / / /'!� 6'i/hke- tv Syy� <br />Zip <br />Property Site Address: 0 fC ll -f"tf Cit / State <br />Contact's Telephone Number: 7/5'— 7•j 7 <br />Contact's EmaiI c A 0 - d b,, 2; 5 ✓ h VIZ <br />Legal Description of Property: i', I �G y�? G'4-� /�/fir �� L414 <br />Section #: Town #: N Range #: W Town of-. <br />*Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system property page. <br />Tax ID # (1-5 digit number; found on tax statement): Ila— <br />Proposed <br />la—Proposed Use of Structure/Addition: r!iL"'tl i? el 15`Iti mkj9, <br />Anticipated Start Date: G _ (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Gvoe'- srrzw <br />Building Contractor: r' � zjka5ewer Installer: ���/r �� f L'✓ � <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITION$ LISTED BELOW: <br />-a <br />,� w�4 <br />r c-lv L-A &LG� , <br />e, <br />Date of staff site visit: 6 — L 1�-,— Ys Initials of site 'sit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICI 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 />x <br />m <br />