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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 />tion/Alteration to Dwelling/Principal Structure <br />Dwelling/Principal Structure $300;Add <br />$200 <br />Commercial/Industrial Structure $300tion/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) $150ion/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) $200ion/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk house <br />Driveways/ & Campground Structures $125ate Statute 59.692(1v) Structures <br />$250 <br />$350 <br />Filling/Grading $150 1 1 Boathouse <br />$500 <br />1$100 <br />Six Month Camping Unit (One Per Year) $100 1 1 Permit Extension (1 Year Extension - Allowed Once) <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: 5/6yao—G Cl �kexy-k' ActA e_Y�',<_-KD!q <br />Property Owner's Mailing Address: (©lL (.0S 44 <br />Cit State Zi <br />Property Site Address: 4crq 4 e ri�blCP _ � 6�cl , �cko5{ •e 4- W 1 :5<4§93 <br />Contact's Telephone Number: <br />Contact's Email: c k e_ r M-, l _ a.J" Qysern p LJ (oo F— - C ©by( <br />l % LCT -1 . <br />Legal Description of Property: VI � k Q t° 4Tel 60 1-Q ke f �cSSes 5O r is PW 13 le,. <br />.19 <br />I <br />Section #: 2.0 Town #: O N Range #:1(c W Town of: <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): 1 45Q o <br />t� <br />Proposed Use of Structure/Addition: 1 j C CL6 ( n, <br />Anticipated Start Date: S' 13 Z d ( (Hone/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: ( Sewer Installer: Ao ,;�f <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />APPROVED <br />Date of staff site -visit: S__q_19 Initials of si visit staffCIZ, <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 />W <br />N <br />0 <br />0 <br />5' <br />0 <br />Fee Rec: 300, 00 <br />F. <br />�z <br />M <br />z� <br />r <br />z <br />n <br />C <br />o <br />G< <br />00 ri <br />