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LAND USE PERMIT APPLICATION — Burnett County, W1 <br />Applicant Complete All Sections Below This Line <br />Permi 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 I Bunkhouse $250 <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(ly) Structures $350 <br />Filling/Grading $150 1 Boathouse $500 <br />Six Month Camping Unit (One Per Year) $100 1 Permit Extension (lYear 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: 11 (I\ w Haw l,� <br />p GkN w <br />Property Owner's Mailing Address: 111 Z d-, 0 D <br />Property Site Address: 3 Pe �,e �� it�ra � State 5 Zip <br />O <br />s �\ 9 <br />q <br />Contact's Telephone Number: %/":�' <br />Contact's Email: lAO(V`)( %Cl Z w,p . \ , ( O V-\, <br />klW <br />Legal Description of Property: <br />Section #: Town #:_25__N Range #: W Town of: Sf Cl ✓ S Q �� <br />*Attach additional page if needed for lengthy description OR attac—h)a copy of the deed OR attach tar system property page. <br />Tax ID # (1-5 digit number; found on tax state jment): Z -! C7 0 S— <br />Proposed Use of Structure/A dition: Cad ` <br />Anticipated Start Date: �rr ZC k (HomeiCabin; Commercial Business; Bedroom; om; Deck: etc.) <br />Building Contractor: b� Sewer Installer: (AQ (1 <br />AREA BELONN'THIS LINE FOR LAND SERVICES STAFF CONENIENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />vel Pe Pe r Al ��a ti -'- -51A- I/V;r <br />Date of staff site visit: J-- so — � � Initials of site i its ff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: 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 />a <br />K <br />-n <br />N <br />0 <br />0 <br />