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CA <br />LAND USE PERMIT APPLICATION — Burnett Countv, WI <br />Applicant Complete All Sections Below This Line s <br />�y <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(1v) 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 GS accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: <o%//�Y% <br />Property Owner's Mailing Address: 2 <br />�- City State <br />Property Site Address: <br />Contact's Telephone Number: ",5?— 27 <br />D' yL C/ LI <br />Contact's Email: O ma / , jr%) <br />Legal Description of Property: ���� 5Ace) <br />Section #:21 Town #:L31_N Range W Town of: i <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): L, q <br />Proposed Use of Structure/Addition:{ a, <br />Anticipated Start Date: :i// (xome'Cabin; Commercial Business: Bedroom; Deck; etc.) <br />Building Contractor: <br />Sewer Installer: <br />AREA BELO`V THIS LINE FOR LAND SERVICES STAFF CONINIENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Date of staff site visit: Initials of sit visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIA 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 />N <br />0 <br />0 <br />2 <br />C" <br />r7 <br />n <br />C <br />0 <br />JA <br />0 <br />p G <br />�o <br />a <br />t�A <br />x <br />a� <br />Fee Rec: <br />