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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 $ISO <br />ec Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(ly) Structures $350 <br />Filling/Grading $150 Boathouse $500 <br />Six Month Camping Unit (One Per Year) $100 jPermit 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: C, ka(`' e S AQ eP5 j ri <br />Property Owner's Mailing Address: U -1 I t I.ltl2- b- SLI e NruL+ IJ 5 e3o <br />City State Zip <br />Property Site Address: 5 K -m e-- <br />Contact's Telephone Number:� (O 3 ((P() -?(P() -?636P - <br />Contact's <br />3 U off - <br />Contact's Email: C�-8"47@com <br />1 CSS 4-,n,' ! "ef— <br />Legal Description of Property: CST CSM U_ P <br />Section #: 3 (7 Town #:_qL_N Range #: 16 W Town OT? 15-5 <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)Lj OS <br />Proposed Use of Structure/Addition: p& -c -k <br />Anticipated Start Date: ,, jA,)e B,t , k1 u (Home/Cabin: Commercial Business: Bedroom: Deck: etc.) <br />Building Contractor: 46 rn e c", -) N C r Sewer Installer: <br />AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />o� eaa� 5 �O �e TiC �Qv� �� eJae <br />Y'�-,j <br />Date of staff site visit: _ Initials of site visit staff: <br />PERMIT APPROVED BY ZONING OFFICIAL -/-'1_, DATE: <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Page I of 4 <br />Burnett County, WI Land Use Application — Rev 1/2018 <br />Ali <br />Q <br />Ul <br />x <br />m <br />z <br />