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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.) $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 Nam le t^i r–,V%A j L �Zli <br />Property Owner's Mailing Address: 70 P—v An G L -A, -\O ?Q8 jgC)ij <br />City State Zip <br />Property Site Address: 50.59'A'–T-,Kb. L -V-4–e Z7 <br />Contact's Telephone Number: QQ 5 – Z2 Q-- SQ -4 9 a <br />Contact's Email: i n�. r \JGi�rI�C _ ��wi `J Gi\t7 �] pr . i4 Q� <br />Legal Description of Property:_ Description: Sec 19 Tn 41 Rg 15 LOT 12 CSM V17 P253 <br />(#333280) (NW SE-FRMLY PRT CSM V16 P213) — <br />Section #: Town #: <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propetry page. <br />Tax ID # (1-5 digit number; found on tax statement): <br />Proposed Use of Stricture/Addition:-��A6d�c, 0' <br />Anticipated Start Date: -� 11 L y 1Y ) ,%J (Home/cabin; Comn7ercial Business; Bedroom; Deck; etc.) <br />Building Contractor: :�k D4(,V0, Pry Q)3,\h ► nti 5 Sewer Installer: 4�1� <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF CONENIENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />-.7 �O/ <br />p � <br />G&A i c.o S Lv s S "rC,r'�en T- <br />�� v s� <br />Date of staff site visit: ) g Initials of site visit staff: <br />3--I o <br />PERMIT APPROVED BY LAND SERVICES OFFICIA DATE: <br />UPON APPROVAL: APPLICANT MUST POST 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 />i <br />1 <br />s <br />