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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 1 Boathouse $500 <br />Six Month Camping Unit (One Per Year) $100 1 lPermit 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: P!R n� S+� IeSor <br />Property Owner's Mailing Address: :70 q Ce,, rct.( Ove S. Ale, 1 vy o e NAI <br />p Ci State Zip <br />Property Site Address: -L((450 !,�- k-fe.{,-1t P&Z t, V -,j3Sr 7%t o IA -31- moi} g93 <br />Contact's Telephone Number: &IZ- Nq 109 <br />Contact's Email: iluk, spoleson @ bcs+-! iA f- C-Cvr. <br />car 2 c< rz. —WeW jr✓ <br />Legal Description of Property: A111,w -e 45-0e- moo, /%t6 �/zBIPS fac�f�iK- L�T3 <br />Section #: a Town #:__3e_N Range #:--J-'3 W Town of: r' 4 GLUrT— GJ r <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): <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: (Home/Cabin; Commercial Business; Bedroom; Deck; etc) <br />Building Contractor:_ _ Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />O C r -C S� 07 k-1 11 <br />Date of staff site visit: Initials ofite visit staff: <br />f pyk-- - 6 -) 9 �� <br />VL"111 AYYKUVLU BY LAINI) NLKVII;LN OttIt-'lAL;y — 6 (7' <br />VAIL: <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 />i <br />Fee Rec. ' <br />LLA 60-41- <br />Cjm <br />