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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 />ec Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br />Driveways/ & ampground 5 ructure` $125 WI State Statute 59.692(1v) Structures $350 <br />Filling/Grading $150 113oathouse $500 <br />Six Month Camping Unit (One Per Year) $100 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:�)hy 1\ wy) ! 3pm,ll�pl/ VU, c (Ase y) <br />Property Owner's Mailing Address: h2 V ' �-11 J W—r <br />,., • City State Zip <br />Property Site Address: � � (j � �cj (� j `� } u )z 5 4 9 -7rl <br />Contact's Telephone Number: I s-- (_0 - C) ��ny-�J <br />Contact'ssir` —C` <br />Legal Description of Property: m * , `� �a�3 3c), i 1 n SNi\j s W) <br />Section #: Town #: N Range #: W Town of: <br />*Attach additional page if heeded for lengthy description OR attach a copy of the deed =taxpage. <br />Tax ID # (1-5 digit number; found on tax statement): <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: J (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 />/max Ae,�— <br />Date of staff site visit: ?� �u Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE:/01 <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 />T <br />11 <br />0 <br />0 <br />CL <br />w <br />h <br />n <br />0 <br />r� <br />0 <br />r <br />b <br />F+ <br />LIN <br />N <br />0 <br />uo <br />0 <br />0 <br />x <br />0 <br />m <br />Q �k <br />00 <br />\v <br />C4 <br />o <br />a <br />� t7 <br />W � <br />W <br />s <br />2 do <br />Fee Rec: <br />talc, l- 79 yo <br />