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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.) 50 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) $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 <br />/Iasse accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: )%ICCt ISL LJcte! jR17Y%A <br />Property Owner's Mailing Address: 2I A Y9, S16, MFL5A Al SS 1- <br />7 -city State Zip <br />Property Site Address: S,2 �u ST15R , Gig SC, <br />Contact's Telephone Number: VF — r7j <br />Contact's Email: b i Q I? 4 <br />Legal Description of Property: <br />Section #: Town #: N Range #: W Town of f' <br />*Attach additionalpage if neededfor 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): ` Cr <br />Proposed Use of Structure/Addition: i _ �.v1. X �.6 <br />Anticipated Start Date: 7LA)V E T , czt)` 9- (Home/Cabin,, Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: 0 61 AIER Sewer Installer: <br />AREA BELOW THIS LINE RESERVED FOR ZONING 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 <br />1 <br />PERMIT APPROVED BY ZONING OFFICIA DATE as <br />UPON APPROVAL: APPLICA MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Page 1 of 4 <br />Burnett County, WI Land Use Application — Rev 1/2018 <br />MR <br />z <br />r <br />b <br />W <br />w <br />x <br />d <br />Fee Re� [JC l <br />Cask <br />