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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 $300Addition/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(ly) Structures $350 <br />Filling/Grading $150 Boathouse $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: <br />Property Owner's Mailing Address: ZR JS' O ('.3 coo , i) -5-Yf o <br />a Ci y State Zip <br />Property Site Address: <br />Contact's Telephone Number: (,> /_2 '-0 0-1-13 <br />Contact's Email: / C/ <br />Legal Description of Property: Lo 7 C S po U. 7 �Ct JS <br />Section #:_Q3 Town #:__S��N Rane #:W Town of- <br />t, <br />*Attach additional page if neededfor 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): 3.3 6, o3 <br />Proposed Use of Structure/Addition: G A2 4 6= E — ('Ir S <br />Anticipated Start Date:— Q — t S' (Home/Cabin; Commercial Business: Bedroom; Deck; etc.) <br />Building Contractor: KotC A l ,yl /t j3kt t L i) CP S 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 />Date of staff site visit: — �� _ ' Initials of ite visits ff J <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: <br />UPON APPROVAL: APPLICANT MU - 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 />x <br />0 <br />W <br />0 <br />W <br />::� II <br />Fee Rec: / 5a <br />C Q- 1 <br />Ji <br />