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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) 1$1001 Permit Extension (1 Year Extension - Allowed Once) $100 <br />*NOTE: After -the -fact permits (permit aquired after construction has begun) may cost up to three times the normal fee. <br />*Communication Towers & Signs require a different application form; see corresponding application, and fees. <br />*Items not listed above will be treated as accessory structures, such as: pergolas, landscaping, etc. <br />� <br />� ._ 1 <br />Property Owner's Name: GRP <br />� RP ru� � � E1L�� f—AV <br />Property Owner's Mailing Address 1 <br />City State Zip <br />Property Site Address: t; i <br />Contact's Telephone Number: /-? " -- on <br />Contact's Email: C A-%(` 7,Pf$ 7C" ��1 �d r (% � 2�j %� �1i �/1 A] <--f— <br />Legal Description of Property:' <br />Section #: 140 Town #: 9 N Range #:15Q_W Town ofz 2--5�f��� <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): I 3 <br />Proposed Use of<jctur ddition:Q /� Q <br />Anticipated Start Date: M/1/18 (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 />APPROVED <br />Date of staff site visit: Initials of site visit staff: <br />6—I�-fig <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 />r <br />a � � <br />0. <br />o p� <br />w <br />a <br />N' <br />o �-1 <br />o <br />v <br />w C] <br />Q N <br />� 'uu <br />O d N <br />S <br />N b <br />� LV <br />a4 <br />C7 0- <br />n <br />0 � o <br />� W <br />fns � S <br />V bpj <br />z .7— Un <br />x Y <br />;i <br />0 <br />Fee Rec: /SO - <br />- ,ice /On/_c <br />