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LAND USE PERMIT APPLICATION — Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />�P <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 />x 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(ly) 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: / " l o r k -r tt. '� C ► v A! j L, So r e h S e'^ - <br />Property Owner's Mailing Address: -lk(e ed �,.1 I�rY�-Ce. �an�vly 5�lg3Cz <br />''nn C�ityy State Zip <br />Property Site Address: �{ �� �1.� �.n C—i2►ry-GC e, A o..n. �Cs L.tvy W T L.✓ C{ g .30 <br />Contact's Telephone Number: 5 01 - 2.3 g- -19 -7 3 <br />Contact's Email: M ok h p C- 5 oy11` £Y\, 0Qg N'L Q `C ovv,- <br />Legal Description of Property: Rel L4 'y <br />Section #:�_ Town #: 4 () N Range #: I 5 W Town of: <br />*Attach additional page if neededfor 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): p o1 ci <br />Proposed Use of Structure/Addition: Cqv lea -.4 '+' ,S- -J rC. ee <br />Anticipated Start Date: OF- 011- 20(11 i� (Ho <br />je/Cabin; Commercial Business,; tBedroom; Deck; etc.) <br />Building Contractor: Aolev tc� ---JI*-Q + �yDog [S Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTEDVI�BELOW:: <br />I � 0 r r c� � ) 4 1 )M c, S AA) - I L VYl V54 z— yy) c+ <br />13`I� <br />Date of staff site visit: Initials of site visit staff: <br />� —13 <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: W 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 3/2018 <br />0 <br />0 <br />c <br />N <br />O <br />0 <br />2 <br />C <br />a � <br />o �4 <br />w <br />O <br />� c <br />C <br />c <br />G <br />z <br />_ o <br />e <br />a Cn <br />CDd <br />b <br />o� <br />� � V <br />z 5 <br />z <br />Fee RA 50 <br />C1 -CCK --if 120601 <br />