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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 $250 <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(1v) Structures $350 <br />illing/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: M u ry Crw <br />Property Owner's Mailing Address: 281-7( F--!,(- <br />City State Zip <br />Property Site Address: Xjyq a4 Ol jOV-Q, <br />Contact's Telephone Number: 7L( 3 `2, <br />Contact's Email: r41--L1/D rnthOILa" /nL,e tna- I iC ,, M <br />C� <br />Legal Description of Property: L O �� C S� • \ �/ Z� �"[ <br />Section #: Town #: N Range #: W Town of: <br />*Attach additional page if needed for lengthv 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): <br />Proposed Use of Structure/Addition:GGYke_ t S d- <br />9nticipated Start Date: i 1 ( <br />7H <br />�ome/Capin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: W� 1 �k6t6 J �kwi% 1/(LjN�Za Sewer Installer: V A <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />UST <br />Date of staff site visit: L Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: 64i DATE: <br />UPON APPROVAL: APPLICANT MU4 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 />s <br />--i Fee Rec: <br />5 <br />r <br />a <br />C <br />m <br />< _ <br />T <br />� <br />SL7 <br />O <br />n <br />o <br />_ <br />w <br />7V <br />� <br />r <br />o <br />� <br />_ <br />0 <br />0 <br />n <br />-o <br />n <br />o <br />� <br />a <br />d <br />t7 <br />CQ1 <br />s <br />a <br />b <br />--i Fee Rec: <br />5 <br />150 <br />m <br />< _ <br />T <br />a <br />b <br />