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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 <br />$200 <br />Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) $150 Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) $200 Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse <br />$250 <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(1v) Structures <br />$350 <br />Filling/Grading $150 1 Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) j$1001 Permit Extension (1 Year Extension - Allowed Once) <br />$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 />� <br />*Items not listed above will be treated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: Jf,,rAld4 SkAU21 CZ1 <br />Property Owner's Mailing Address: 1-1W <br />n City State Zip <br />Lzt. <br />Property Site Address: I r�� )e- D u.) R I �e- nd DAM l s'y -?n <br />Contact's Telephone Number: G -S-qgl I <br />Contact's Email: NOAlL'r�p(1�V/�n0o yG�S/VI <br />Legal Description of Property: l a f 5-6 Bay t Un 5 }Q 11/ L ✓2 6 /V -P S <br />Section #:7 Town #:_qo__N Range #: W Town ofAAklg,t(d <br />z <br />0 <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page. <br />(�0 <br />Tax ID # (1-5 digit number; found on tax statement):_ / L/ a 9 9' <br />a <br />Proposed Use of Structure/Addition: p i i p W r <br />Anticipated Start Date: (Home/Cabi Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: S p I f Sewer Installer: & 6 <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />N <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />t <br />i <br />/.nf <br />Date of staff site visit: 62 -240 - I ZS Initials o site visit st -� <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: (p� <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 />X <br />N <br />0 <br />0 <br />s <br />� <br />CD <br />CD <br />a <br />o <br />r <br />S' <br />5 <br />0 <br />1 <br />� <br />o <br />m <br />V <br />z <br />0 <br />m <br />o <br />(�0 <br />a <br />o <br />N <br />r, <br />a <br />CkEc o3o I <br />rR <br />X <br />0 <br />0 <br />r <br />5 <br />C <br />m <br />CkEc o3o I <br />rR <br />