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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 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:_ <br />Property Owner's Mailing Address: y_y8:I0 <br />S <br />Property Site Address: /'t City State Zip <br />Contact's Telephone Number: S^ 2 c % <br />Contact's Email:_ p.4 y '� ✓1'� -1XV <br />Legal Description of Property: 9 2L t A�- & (0,C) ( S oc 0 r V t d <br />Section #: It Town #: 4 O N Range #: Lf W Town of: J �C4VI- � <br />*Attach additional page if needed for 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): I <br />Proposed Use of Structure/Addition: 01e C'� 6 X 56 <br />Anticipated Start Date:_ 11 t � ( (Home/Cabin; C mmercial 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: Initials of site visit staff: <br />s�aa,1� <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 />0 <br />N <br />0 <br />ro <br />d <br />F1 <br />b <br />Nq <br />CD <br />CD <br />f <br />P <br />3 <br />y <br />a <br />IA <br />ti <br />d <br />A <br />3► <br />N <br />a <br />U <br />'7T' <br />-10 <br />N <br />o <br />, <br />z <br />— <br />r <br />'� <br />ry <br />O <br />ti <br />n <br />Co <br />o� <br />Fee Rec:� <br />x <br />0 <br />A <br />3► <br />N <br />a <br />a <br />N <br />o <br />, <br />z <br />— <br />r <br />'� <br />ry <br />O <br />ti <br />n <br />Co <br />2 <br />0 <br />