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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 />X 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 Boathouse $500 <br />Six Month Camping Unit (One Per Year) $100 Permit 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: �Awke,K/ 700 o % I v- -4n- <br />Property Owner's Mailing Address: Ao e4 <br />City State Zip <br />Property Site Address: Zl110 9.4witi) '04excr �rocyk;` s ii-yw , 4clir J'XP 111i <br />Contact's Telephone Number: 61-z — <br />Contact's Email: &I o,�vdi/,C©�ti <br />Legal Description of Property: <br />Section #: 21 Town #:=N Range #: Z8 W Town of: 1-4,oe- �- Gu•(L <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): <br />Proposed Use of Structure/Addition: Dy -4K <br />Anticipated Start Date: Ajn (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />T <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: ^� Initials of site visit staff: <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 I of 4 <br />Burnett County, WI Land Use Application — Rev 3/2018 <br />0 <br />r <br />0 <br />� <br />Fee Rec:'� <br />CA <br />e <br />o <br />n U <br />z <br />-� <br />w <br />�t <br />b <br />