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c <br />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 jWl State Statute 59.692(1v) Structures $350 <br />Filling/Grading $150 lBoathouse $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 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: Stl () 1 7 E LO jE- `/AA Cr <br />Property Owner's Mailing Address: 6 `s- S 71f -T !� r .S h t. )/ 70 <br />City State Zip <br />Property Site Address: f eti W7 s(8'�� <br />Contact's Telephone Number: -7/,5-- 6 O 3--- SS C7 -L <br />Contact's Email: /v /A <br />Legal Description of Property: Gov k -d 7 PG j-- E S G 3c, L— Wo <br />Section #: 3 S– Town #: g N Range #: /6 W Town of: &-A) opt/ <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):3 33 V / r 1) <br />Proposed Use of Structure/Addition: 570 f o-) S ►ti e- 1) -a�-x / 6 <br />Anticipated Start Date:- :U y IV (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: AIA Sewer Installer: /1//A <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Date of staff site visit: I — I U Initials ofvisit staff: <br />,s J� <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 />o am <br />d <br />0 <br />5 <br />d <br />z <br />a <br />Fee Rec: <br />