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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 $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(1v) Structures $350 <br />Filling/Grading $150 Boathouse $500 <br />Six Month Camping Unit (One Per Year) $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: gr 1t L z DA/blq V" / IrA m5 d e/i <br />Property Owner's Mailing Address: 0 X S �t I <br />ff I City, State Zip <br />Property Site Address: ,S fr �+ G ! if P✓ J U I T'to'l �) QJ y G�N4� o,r`' �y 6 <br />Contact's Telephone Number: <br />Contact's Email: <br />Legal Description of Property: <br />Section #: (; % Town #:�N Range #:Town o£ SCC <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. 7 <br />Tax ID # (1-5 digit number; found on tax statement): % ! 2 <br />Proposed Use of Structure/Addition: /�-o vn e <br />Anticipated Start Date: (� -- y— �_ (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: U� tcy I� ON+�� Sewer Installer: (Ec^1/'(A tz, i <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />T14114Q PVDI%4rr Tc CITT2TF( I' TO ALL CONDITIONS LISTED BELOW: <br />Date of staff site visit: Initials of spite visit staff: <br />6�iy`� <br />PERMIT APPROVED BY LAND SERVICES OFFICIA4Ajile DATE: <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 />�4 <br />Fee Rec:1>3vol <br />