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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(1v) Structures $350 <br />Filling/Grading $150 lBoathouse $500 <br />Six Month Camping Unit (One Per Year) $100 1permit Extension (1 Year Extension - Allowed Once) $100 <br />*NOTE: After -the -fact permits (permit aquired after construction has begun) may cost up to three times the normal fee. <br />*Communication Towers & Signs require a different application form; see corresponding application, and fees. <br />*Items not listed above will be treated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: Ah�� <br />Property Owner's Mailing A l � <br />�. TIP <br />City State Zip <br />Property Site Address __�� <br />Contact's Telephone Number: <br />Contact's Email:—� <br />Legal Description of Property: P OLIN <br />Section #: Town #: N Range #: W Town of� bt) �$ <br />*Attach additional page if needed for lengthy description ORFF attach a copy of the deed OR attach tax system propertypage. <br />Tax ID # (1-5 digit number; found on tax statement): 1 S 7 3 1 <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: (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: -S1-1111f- Initials of site visit staff: y <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: -5/m/V <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 />r <br />0 <br />0 <br />a <br />N <br />0 <br />o� <br />0 <br />L I~ <br />P <br />'S <br />z <br />o� <br />s Fee Rec:� <br />