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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 V$300Addition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure ition/Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) ition/Alteration to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) ition/Alteration to Bunkhouse $150Deck/Stairs/Patio/Retaining Wall/Sidewalkkhouse $250Driveways/ & Campground Structures 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: S�3 S- as-� <br />City State Zip <br />Property Site Address: 2S o�� � c k/,� <br />Contact's Telephone Number: 6S/- as3- G %a o <br />Contact's Email: )� V/ 13e 0 -IozS its' . CIllr ,Q <br />Legal Description of Property: l�O t / 3 X014,My/ ! CJ 4;, f er/q <br />Section #: Town #: 3 l N Range #:_��W Town of: Me ek 0 P% <br />*Attach additional page if needed for 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): 12- 7 Z3 <br />Proposed Use of Structure/Addition: IO / e , C- lPao /e -k <br />Anticipated Start Date: (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: �j f 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: -7/Z U Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: —DATE: 7 2 �o <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 />a <br />10 <br /><� <br />ti <br />b <br />1 <br />H <br />Q <br />H <br />o <br />S <br />� <br />s <br />o <br />•per <br />r <br />r <br />O <br />° 'FF <br />b _ <br />O <br />y <br />e <br />d <br />CD <br />N <br />'v <br />°0 <br />d <br />y <br />V <br />,;X-- <br />vv <br />� <br />K_ <br />N <br />o <br />� <br />z <br />N <br />z <br />W <br />x Fee Rec: <br />lop <br />�s � T <br />