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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 1 lAddition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure $300 1 lAddition/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 />ec Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br />Driveways/ &(a—M579TQypd S ructur $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 as accessory structures, such as: pergolas, landscaping, etc. <br />n <br />Property Owner's Name: 1 <br />e. <br />Property Owner's Mailing Address: <br />City State Zip <br />Property Site Address: � D 1n(� 10 3 t - CL (4 -7 Q S ll ran (-A)Z 5 U 6 "7 nl <br />Contact's Telephone Number: <br />Contact's Email:&Wu)�j�ftmal, �,�� �\ .�0Y� <br />Legal Description of Property: Ln} ,,/A Q5 01 y 1 t P AT E)( N1 3C) n <br />Section #: Town #: N Range #: W Town of.—W f <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): I9Sy QCj <br />Proposed Use of Structure/Addition: ('�I�,,/) t^all/L- 4- 11 , • � C <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 PEE71T IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Date of staff site visit: Initials of site it staff: <br />S <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 />