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LAND USE PERMIT APPLICATION — Burnett County, WI a <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure $300 <br />Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure $300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) $150 <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) $200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Driveways/ & Campground Structures $125 <br />Bunkhouse <br />WI State Statute 59.692(ly) Structures <br />$250 <br />$350 <br />Filling/Grading $150 <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) $100 <br />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 />*Items not listed above will be treated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: K) (t,— -A.- jr-5s <br />Property Owner's Mailing Address: 3f 7 L cS"Py <br />Property Site Address: <br />Contact's Telephone Number: 76 3 — Z ON " % Z lk- V <br />U-IQ.Af <br />70 <br />City State Zip <br />Contact's Email: /i'�/e fliSpi'1�('ac�eTill�i < tom, <br />Legal Description of Property: LOT CSM NOD V3 f l u (`6L� 3) -A /9%Ct i <br />Section #: 35 Town #:�N Range #: 15 W Town of- <br />*Attach additional page if neededfor 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): d2 —7 <br />Proposed Use of Structure/Addition: S'%31 -Az"F <br />Anticipated Start Date: 6 (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: n%��— Sewer Installer: INIA'•• <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />— S ►-�� �e s �0 6 0 6+a%A-k..k- 6, �8 -) 5 - <br />MSI[ <br />lJ1IeO 2r.0 r' !it/n�a4v 1141" a49 V a <br />Date of staff site visit: I S - J Initials of site sit s of <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />APPRO VE UP, Page 1 of 4 <br />Burnett County, WI Land Use Application — Rev 3/2018 <br />o <br />L <br />x <br />in <br />::� I I <br />Fee Rec:1/6-0 60 <br />ai-7ivt <br />!. <br />