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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 $300Addition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure $300FIWI <br />Addition/Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) $150Addition/Alteration to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) $200Addition/Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br />Driveways/ & Campground Structures $125 State Statute 59.692(ly) Structures $350 <br />Filling/Grading $150 1 lBoathouse $500 <br />Six Month Camping Unit (One Per Year $100 1 jPermit Extension (1 Year Extension - Allowed Once) Isloo <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: Tc>m 1 E <br />Property Owner's Mailing Address: II'�t3 PErJAS`W\)'Vq!A AIvE IJ CvwKINk4 D►'t/1I 553tt, <br />Property Site Address: �'7 ! 3 ate! j C �F Li,C tate Zip /-%,4L7,, <br />Contact's Telephone Number: 7(63 2-4, -COW-7 w 5 r IJTIo `� <br />Contact's Email: -+W i h PL-Av.C10 n % cV_- • Lc --j <br />Legal Description of Property: SCE A rM C -t4 Z'b "" r <br />Section #: Town #:_`�l N Range #: 16 W Town of: 0 A 0 <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br />Tax 1D # (1-5 digit number; found on tax statement): <br />Proposed Use of Structure/Addition:y i t-tT4 ED lti4A(iz <br />Anticipated Start Date: <br />p ASA P (Home/Cabin; Commercial Business; Bedroom; Deck, etc.) <br />Building Contractor: GL -0 K1CVA_r-Y Ilk'%-bi`1LS Sewer Installer: r4 <br />C Is ti:: -'r c ,-r S i. <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECTTOALL CONDITIONS LISTED BELOW: <br />Na s /IGQVYYl tt ✓l �'� 15 GC CSS 7 <br />f�rc�vr <br />Date of staff site visit: Initials of a visit staff: ` p <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL. -DATE:— <br />UPON <br />ATEUPON 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 />N <br />U <br />UQ <br />0 <br />4— <br />F�eeLRec: <br />