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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 $3001 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(1v) Structures $350 <br />Filling/Grading $150 1 lBoathouse $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: pee�rgolos, landscaping, etc. <br />Property Owner's Name: L„ a r y,-% <br />Property Owner's Mailing Address: I IO 16, c> 1_j Q. TO <br />�[, / City State Zip <br />Property Site Address:p� 6 S7i /, �� FP'pQle�) C (i(i�� <br />Contact's Telephone Number: -7/ "3a 7' y&6 S <br />Contact's Email: QQg qand0(Y'VNqry t', cor" <br />Legal Description of Property: CAS SW SW <br />Section #: Town #:�N Range #:W Town of:S,_Lake, <br />*Attach additional page if needed for lengtl?v description OR attach a copy <br />, of the deed OR attach tax system property page. <br />Tax ID # (1-5 digit number; found on tax statement): 01 3 C3 59 <br />Proposed Use of Structure/Addition: 6—C, rac <br />Anticipated Start Date: _j/ — 17 (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: Se 1p Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />0 Y,,-, e1z �_ � I o t-, � ) (-� n <br />Date of staff site visit: Initof ite visit staff: <br />ials <br />PERMIT APPROVED BY LAND SERVICES OFFICI /rr✓ 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 />rn <br />s <br />0 <br />a <br />N <br />0 <br />T_ _1D <br />P <br />P <br />i Fee Rec:: <br />c�necK# 3a5 1 <br />�� <br />rRE <br />1m <br />C= <br />rV <br />C=) `V <br />