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LAND USE PERMIT APPLICATION — Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />Perrpit 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 I Bunkhouse $250 <br />Driveways/ & Campground Structures $125 1 IWI State Statute 59.692(Iv) Structures $350 <br />Filling/Grading $150 1 lBoathouse $500 <br />Six Month Camping Unit (One Per Year) 1$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:e <br />Property Owner's Mailing Address 15 I M I <br />City 1i State Zip <br />Property Site Address:-lbgb� IIl1dPILWO Of►YP_I W1 �)4640 <br />Contact's Telephone Number: ISI. 4A5, ILN3 <br />Contact's Email: * rPi1 K ryy6S4nyj `. cam <br />Legal Description of Property: LLft i asm -* 3LZ5 V 18 PIA (60v Lai <br />3) <br />Section #:)I Town #:___3_q_N Range #:/Pj_W Town of: 1r)JA,4, Lap_ <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax ivstem property page. <br />Tax ID # (I-5 digit number; found on tax statement): X21j / <br />Proposed Use of Structur Ad ition: 7y � (,t�D11) V f) �aTl0�(1 ��r w�✓' S � �Z <br />Anticipated Start Date: F (Nome/Cabin; Commercial Business; Bedroom; Deck, etc.) <br />Building Contractor: Lj k to J ip— MQ ypus Sewer Installer: p j <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />�0 5 <br />� 1 % <br />Date of staff site visit: r` Initials of ite visit stain <br />PERMIT APPROVED BY LAND SERVICES OFFIC DATE: <br />UPON APPROVAL: APPLICANT MUVr 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 />0 <br />d <br />0 <br />N <br />0 <br />0 <br />5" <br />ao <br />9 <br />N <br />m <br />r <br />