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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 Name: i ,Zei#, ;, 4 all de/ t -A Q -1 <br />Property Owner's Mailing Address: �20.Q9 r Se u Ay7 AY -5- LOk <br />_ _�/ City State Zip <br />Property Site Address: 2 9b7S I . 1`c: //a u� AP,Jera /�Vt T�0.n ��� �� /h i�l <br />Contact's Telephone Number: <br />Contact's Email: d&G, n q(� S ye— '/G 0 W <br />Legal Description of Property: <br />Section #:_ 7 Town #:_t,(O _N Range #: W Town of. t/," <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):_ j ;t 3 g <br />Proposed Use of Structure/Addition: G�; n <br />Anticipated Start Date: !f SA ,o (Home/Cabin; Commercial Business; Bedroom; Deck; etc) <br />Building Contractor: Oen - bku(d LJ / S U b� Sewer Installer: u�in S 54 n q,/r �ist u <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 site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: <br />UPON APPROVAL: APPLICANT M ST 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 />