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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 $300rAddition/Alteration <br />ition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure $300ition/Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) $150 to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) $200ition/Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk khouse $250 <br />XDriveways/ & Campground Structures $125tate Statute 59.692(1v) Structures $350 <br />Filling/Grading $150house $500 <br />Six Month Camping Unit (One Per Year) $100mit 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 T"I structures, such as: pergolas, landscaping, etc. <br />c`H1Property Owner's Name: KfnRic k6 CJ v i <br />Property Owner's Mailing Address: ! (UI q5 (old ✓cJ V Cb5 f f V J 5 -1-- <br />Property Site Address: 27897 S�rci c,�l U VV� J <br />Contact's Telephone Number: -7/ 5' 377 <br />Contact's Email: km506/d <br />Legal Description of Property: CSM V Iq F ZS iL7Zq 0_7 <br />Section #: 25 Town #: 40 N Range #: 15 W Town of- �SayJ <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax systetn property page.* <br />Tax ID #(1-5 digit number; found on tax statement): 5_(6/11 <br />Proposed Use of Structure/Addition: o <br />Anticipated Start Date: Home/Cabin: Commercial Business; Bedroom: Deck: etc.) <br />Building Contractor: Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PER�MMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />"k qc_-610/44E�^w►1 / /S �r %��t�jo { fcfiGP.H'1 P,�� J Z x Z I <br />y , <br />�,5 �� f ,s q/ <br />-,� ��a�) s s�o�n m� �s v7 f7 l.511qg xis <br />-10-I� S6 06 <br />Date of staff site visit: Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES 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 3/2018 <br />a <br />-I <br />0 <br />0 <br />v <br />IN <br />0 <br />0 <br />n <br />Fee Rec: <br />3Y5`Q;T <br />