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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 <br />Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure $300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) $150 <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) $200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />Lec Stairs/Patio/Retaining Wall/Sidewalk <br />Bunkhouse <br />$250 <br />Driveways/ & ampground 5ructure- $125 <br />WI State Statute 59.692(1v) Structures <br />$350 <br />Filling/Grading $150 <br />Boathouse <br />1$100 <br />$500 <br />Six Month Camping Unit (One Per Year) $100 <br />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: py�ergolos, landscaping, etc. <br />Property Owner's Name: t^� Y V\ t �1; <br />!� I , ��� 1� l,1 <br />Property Owner's Mailing Address:: <br />5-NL <br />Property Site Address:��}� C j , �( i 4: f (� <br />State Zip <br />j `� 11rQ�` 1_ )z �� {a 6 -7 <br />Contact's Telephone Number: I - Sao <br />o 0 S- � ny) <br />Contact's <br />Legal Description of Property: <br />" T E 5� k; .IC), j n <br />Section #: Town #: N Range #: <br />W Town of: <br />*Attach additional page if needed for lengthy description OR attach a copy of thedeed OR at ax system pr ape ty e. <br />Tax ID # (1-5 digit number; found on tax statement): <br />Proposed Use of Structure/Addition: ' �,�� •f 3Lj <br />Anticipated Start Date: <br />p <br />(Home/Cabin; Coirnnercial Business; Bedroom; Deck; etc.) <br />Building Contractor: <br />Sewer Installer: <br />AREA BELOW THIN LU E FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />70 8" 8x <br />Date of staff site visit: `� 7O / Initials of site visit staff: 9�//-7/-" <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: %d <br />UPON APPROVAL: APPLICA T 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 />III <br />0 <br />0 <br />a <br />t <br />w <br />-4 ee <br />C►ee Rec?? Q 5.f <br />N K y8A, CAL <br />L <br />c <br />z <br />Guy <br />N <br />a <br />