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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 bettrreeaattedd as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: I -CKy 641 cLAj0,1,- e?)/ <br />Property Owner's Mailing Address: nq eSIY020 <br />City State Zip <br />Proparty Site Address:_ 7 r 1a city l _ <br />Contact's Telephone Number: '% (- q 2 7 T j <br />Contact's Email: <br />Legal Description of Property:_ Oaf— o'F 661 G4 ((3 S (off` <br />Section #: % _ Town #:_ _N Range #:�W Town of: /,f AA J Aj <br />*Attach add0ional poge if needed for lenothy description OR attach a copy of the deed OR attacn tax system properti, page. <br />Tax ID # (1-5 digit number; fond on tax statement): <br />Proposed Use ofStnicture/addition:_ 1L' W j -f2,' <br />Anticipated Start Date: _—_ /Honie/Cabiircial Business; Bedroom; D ck; etc.) <br />Building Contractor _ ­ ____ Sewer Ins tai <br />ler:_AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />4VWS �� �xPat� 5/odl �e�5 <br />�7 e,4ACi9ACA OA- lne�l� � � m f g f -t h-64 ` R 7 N l/ <br />l h `Zod 7/ JAI Sf V e.Ge l',�e�t rpt CQ�l9 �� 18. <br />Date of staff site visit: 2-// " Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: �9Lg <br />UPON APPROVAL: APPLICA' T 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 />C" <br />b <br />Q <br />Lill <br />CD <br />N <br />5' <br />as <br />U <br />Z5, <br />z <br />z <br />NJ <br />C= ee Re ��.m <br />7010 <br />C� <br />c <br />0 <br />rV <br />O <br />