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LAND USE PERMIT APPLICATION — Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />y � <br />c <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 1 Permit Extension (1 Year Extension - Allowed Once) $100 <br />*NOTE: After -the -fact permits (permit aqui red 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: Ey `���e- 1 ��C7 h� i �✓ <br />Property Owner's Mailing Address: /--? e7 <br />D5 ����c� �y �� <br />City State Zip <br />Property Site Address: GG1�?S -i he.c' LAre skett ohe— kiT Ste97( <br />Contact's Telephone Number: / _,' 75 <br />Contact's Email: L rJ" `PS � FCOr' . e ir-/ve-k- - 4^-fe <br />Legal Description of Property: 1p.�1 "� S 0.Y S t c b <br />Section #:13 Town #: 3 S N Range #:� W Town of: She 11 t4 t -,q <br />*Attach additional page if needed for lengthy description OR attach as copy of the deed OR attach tax system property page. <br />Tax ID # (1-5 digit number; found on tax statement): 3 / I p <br />Proposed Use of Structure/Addition: STOrA <br />Anticipated Start Date: <br />p —CJD _� (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: S e.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 />6-acs-�g <br />Date of staff site visit: Initials o4s*te visit staff: 58 <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL• DATE: <br />UPON APPROVAL: APPLICANT UST 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 />� O <br />Y, <br />o � � <br />� � 5 <br />P <br />^o <br />m <br />o .- <br />z 0 <br />0 <br />^n <br />c <br />0 <br />c <br />Q <br />o w� <br />a5 <br />d <br />�Q 5 <br />•� W <br />z � <br />Fee Rec�S� <br />x Co�s1� <br />Y <br />