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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 I Bunkhouse $250 <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(ly) Structures $350 <br />Filling/Grading $150 Boathouse Issoo <br />Six Month Camping Unit (One Per Year) $100 Permit Extension (1 Year Extension - Allowed Once) Isloo <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: Q ��- ,T 1-/m f , , {ie,-lj <br />x'889 <br />Property Owner's Mailing Address: 10;Y�- f� <br />a City State Zip <br />Property Site Address: <br />Contact's Telephone Number: l/-el(15 � <br />7 i s- 3y"9 - �aq o - /ate /�h.- <br />Contact's Email:A1,5� /� � Iv -P n �,J.Zj p . e�2 //! <br />Legal Description of Property: t-- &T �13 C S ;" \. I \P 3 /N C.ou Lc) -r <br />Section #: AS— Town #: "39N Range #:__J_�, W Town of: F E i0t) �,/ <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): 9 Q S <br />Proposed Use of Structure/Addition: atin, " re.6"1 l�— <br />Anticipated Start Date: (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: ) CQ_ Sewer Installer: -ZP3 S; 1 14 L L. C)�:> <br />AREA BELOW THIS LINE FOR LANDS RVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Date of staff site visit: Initials of s4e^yisitstaf <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: - e -le <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 />