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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(ly) Structures $350 <br />Filling/Grading $150 Boathouse $500 <br />Six Month Camping Unit (One Per Year) I $100 Permit Extension (1 Year Extension - Allowed Once) $100 <br />*NOTE: Atter-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: a ea( A80,,Me. )K, <br />Property Owner's Mailing Address: 1r32 -12-40+L, V F U AQ 5&446 <br />Mq r, �t <br />Property Site Address: L ! `?J�l VNt CoeV1e— CityYAM- <br />State Zip L� �qy���� <br />Contact's Telephone Number: <br />Contact's Email: <br />Legal Description of Property: L o 4r , <br />Section #: -2 Town #:��N Range #:_ W Town of: Lirtt0y1 <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 S rjQ`7 <br />Proposed Use of Structure/Addition: GoIL lrL <br />Anticipated Start Date: (,/I 1,(Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: Z.pq tt('X'wS �W 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: Initials of s' a visit taff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIA DATE: <br />UPON APPROVAL: APPLICANT M T 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 />0 <br />r <br />0 <br />`o <br />V <br />n <br />O <br />W <br />k1k) <br />I We <br />r <br />b <br />K� <br />1 4 <br />'m <br />:�! II c,� <br />Fee Rec` .0z) <br />L'�K� /0 <br />o <br />N <br />as <br />a <br />R <br />