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a <br />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 x 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(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: Jim and Lynn Shaw <br />Property Owner's Mailing Address: 1818 Pin Oak Ct Rockford IL 61072 Ser—Y'%o7-- eIo <br />City State Zip <br />Property Site Address: 3605 CountyRd A <br />Contact's Telephone Number: <br />Contact's Email: shawlnjm@gmail.com <br />Legal Description of Property: Lot 2 CSM 14/86 <br />Section #: 24 Town #: 40 N Range #: 15 W Town o£ Jackson <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): 5597 <br />Proposed Use of Structure/Addition: Addition to garage <br />Anticipated Start Date: ASAP (Home/Cabin: Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: Northland Builders Inc Sewer Installer: NA <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Date of staff site visit: Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: 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 />4e 2—F520 k� <br />01 <br />x <br />d <br />Fee ]RecA <br />CIL,* 3x31 C/ <br />-r <br />n <br />[/ <br />R'I <br />A <br />"kms <br />r <br />�e <br />C'p <br />-r <br />