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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 />on/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure $300on/Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) $150 to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) $200ion/Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk ouse $250 <br />Driveways/ &Campground Structures $125ate Statute 59.692(ly) Structures $350 <br />Filling/Grading $150ouse $500 <br />Six Month Camping Unit (One Per Year) $100t 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: L- v�--;rLXz— — <br />Property Owner's Mailing Address: S % <br />City State Zip <br />Property Site Address: j�p>� Z W� S 1412>0 <br />Contact's Telephone Number: Cf.�.�t> '2-� (q 10127— <br />Contact's <br />aContact's Email: O MA. %L— . CipA14% <br />Legal Description of Property: l55 L kopjJa I LAW -G i2D �S'Do�tJ�"`t2. � VJI S <br />75104 <br />Section #:_ k% Town #: `qQ�N Range #:_tq W Town of:'5C.0= j <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br />Tax 1D # (1-5 digit number; found on tax statement): <br />Proposed Use of Structure/Addition:�{L? – DOI.e <br />Anticipated Start Date: j <br />a5 (Home/Ca n; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: '5r-(1EFfEC. cg* i i. XM -Q4 ewer Installer: a(a <br />AREA BELOW THIS LINE FOR LAND SERVICES STAF ' COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT/TO ALL COP, DITIONS /LIST�E.D BELO / o� <br />A Fu'PROV[D 12fl xo, //A /4 //a A., - <br />Date of staff site visit: ✓ Initials of sit vi. 't staff <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: <br />UPON APPROVAL: APPLICANT M 7ST 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 />a <br />0 <br />CL <br />5 <br />(A <br />11 <br />Fee Rec: <br />(2k ko <br />