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LAND USE PERMIT APPLICATION - Burnett County, WI <br />Applicant Compleie All Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure $300 ;Addition/Alteration <br />on/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure $300 on/Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) $150 on/Alteration to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) $200 to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk ouse $250 <br />Driveways/ & Campground Structures $125 te Statute 59.692(ly) Structures $350 <br />Filling/Grading $150 lBoathouse $500 <br />Six Month Camping Unit (One Per Year) 1$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:_ <br />Property Owner's 1vlailing Address:—k3&lo /VIIJ'O W N l R,,_ <br />r Cit StatWip <br />"- �t tr�� Y <br />Property Site Address: 11 5 I i1iX"+� �N V'JH lzvr�rD Sib' 1A1 l <br />Contact's Telephone Number: ba, y 1 <br />Contact's Email: `� � fi5i. �i`h-(� ,� 6C9 & <br />Legal Description of Property: LD•(, b � 1 Z C Sj� "*LA450 V ��� P �'7 �.y �� ti <br />Section <br />Section #: V�7 Town #: N Range #:E1 p.G), W Town of. jS t1 <br />*Attach additional pave if needed for lengthy description OR attach a copy of the decd OR attach tax system property page. <br />Tax 1D # (1-5 digit number; found on tax statement):__ <br />Proposed Use of Structure/Addition: R t - �.r~�r ,ala (,J PtLA- V c,- <br />Anticipated Start Date: 1-i /C22,0� 1—(Home/Ca in; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: %��� Sewer Installer: <br />AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO /ALL COND•I/TIO�N�S L.I/STED BELOW: <br />NPPROVID <br />Date of staff site visit: 6/S' /,r Init' Is of site visit staff: <br />4PERMIT APPROVED BY ZONING 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 1/2018 <br />m <br />0 <br />0 <br />5 <br />N <br />0 <br />0 <br />r� <br />d <br />,-.0 6 <br />'d <br />w <br />I gyp' <br />Y <br />Fee Rec: 1 1�5 e� <br />