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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.) $15 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(ly) Structures $350 <br />Filling/Grading $150 1 lBoathouse $500 <br />Six Month Camping Unit (One Per Year) 1$1001 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:��ptCq�� t u�2-- <br />Property Owner's Mailing Address: UJ4�>?> O C e&. r Q -J p <br />1,h <br />Lr 1 Ct}}� State S` $moi <br />Property Site Address: 2 g� Z t G1 c_ k �tc (�4VNWt <br />Contact's Telephone Number: �I S - S 1�E33 JesS1n �eCk� <br />Contact's Email: A est+ C -k -SS E> C� <br />t_oT l CSrA V CSM V PS ('.1 (aoV Lc; r a^ <br />Legal Description of Property: Sea `Y f- & oy t► -r 3 S e. c- m <br />Section #: 145 Town #: A'd N Range #:___I! W Town of SC -0A4 <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br />Tax ID # (1-5 digit number; found on tax statement): g q3 <br />Proposed Use of Structure/ddition: G �-'ht_ <br />Anticipated Start Date:O`7 b`L/ j� (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: Calc Ca�S L � 1-,X L- Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: II <br />GO' -S �lvc.��Gn C3,,reo��% �� Uy> i7Y� a ��0�C, �dv►1c1 iav1 <br />1 v111 <br />Date of staff site visit: -6 _ Initials of s'te visit taff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIA DATE: <br />UPON APPROVAL: APPLICANT MLtt—p-- <br />O COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Page I of 4 <br />Burnett County, WI Land Use Application — Rev 3/2018 <br />b r <br />a <br />C <br />N y <br />y <br />00 <br />0. <br />a � <br />o � � <br />z � <br />0 <br />00 �.- <br />b <br />CD <br />w n G <br />� y <br />e <br />a <br />0 00 <br />n <br />tro'Q <br />0 <br />rn' <br />n' <br />v, <br />oo <br />H <br />"N <br />L Ub <br />Q <br />z (i) <br />x <br />y <br />00 <br />-iFee Rec: 1 <br />F a of <br />tz {'i cr%- I ;C r S V C <br />