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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 I Bunkhouse $250 <br />Driveways/ & Campground Structures $125 IWI 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) $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 betreatedas accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name:_[Gu4 <br />Property Owner's Mailing Address: 8jDS- W', U ka t-, 12d LJ kV-' f L,�L -5 416 93 <br />City State Zip <br />Property Site Address: S4- wt -e- <br />Contact's Telephone Number: 7713- -733 106-9 <br />Contact's Email: ih-7rt7 �,e l "o .3 1 .L0'"^ <br />Legal Description of Property: J a R /Sk) V6 -5'w IEK 37 % 70.6 -,E1 -39V <br />Section #: Town #: 'VO _N Range #: W Town of: 13 ac- k5o n, -3Y <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): S 42 03 <br />Proposed Use of Structure/Ad ition: �r-�c 2.t w X47 / <br />Anticipated Start Date: J �c Ty `2 a-018 (Home/Cabin; dommercial Business; Bedroom; Deck; etc.) <br />Building Contractor: Geo r`I e Sewer Installer: .9X S i'17�i vvq <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL COjNDITIONS LISTED BELOW: / <br />mow �/�� �UL/t_ y /'S t'� d/ J,s �7 2 SZiIG�J4c/�s�h <br />de -G /A �e �qll y mwto Ails ��rP10�0 0111 nE--9-/ �zv 10G1'7' OAIA i <br />Date of staff site visit: - Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIA �'%2.C�l 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 />-3 <br />z <br />x Fee Rec: oZco•oc <br />�, checK p t� <br />C— <br />C= <br />N <br />N C7 <br />N <br />O (AL < <br />V <br />c <br />