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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 S$200Addition/Alteration <br />ition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure ition/Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) ition/Alteration to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) to Bunkhouse $150 <br />5(Deck/Stairs/Patio/Retaining Wall/Sidewalkkhouse $250 <br />Driveways/ & Campground Structures State Statute 59.692(1v) Structures $350 <br />Filling/Grading $150 1 lBoathouse $500 <br />Six Month Camping Unit (One Per Year) -$100Y 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 />Property Owner's Name: 4E-54;6- <br />Property <br />ESC/EProperty Owner's Mailing Address: /q d E y FL 2m3 <br />City State Zip <br />Property Site Address: /9� S RA/;V`,6D&) �� ��p i2 lis .5S� e / <br />Contact's Telephone Number: 419—,9161-6127 <br />Contact's Email:jC•.•4!�- @ 4, Ca/I% <br />Legal Description of Property: CSM my , �q a� <br />Section #:_ Town #:_�N Range #: W Town of:rLuSk <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br />Tax ID # (1-5 digit number; found on tax statement): 1:Z S !A L �yT_ <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date:A0!;:zLsR AP��� j/�g/ (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: 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: 1 f Initials of si visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICI 4�:::::::DATE: O <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 />a <br />2 <br />'17 <br />O <br />0 <br />a <br />E. <br />N <br />0 <br />0 <br />n <br />y <br />d <br />a <br />