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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(1v) 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 be treated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: J o�� �„�� Vt AV 10 ff <br />Property Owner's Mailing Address: <br />1 ( / I \ City State ' Zip <br />Property Site Address: 2 7 s2 -`f '� ��t5 I �e U[ `� /-a 1� �7� t,(S,�6 C, <br />Contact's Telephone Number: -7 1 b I -7 l 716'- 7q6 ' 56 i 7 <br />Contact's Email: ��,� �, V►aV'�i n op bIIII&L' C-aov► <br />Legal Description of Property: I -c <br />Section #: _Town #:� _N Range #:__L (�C _W Town of: C,, Cr K <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): 5 e-,,- a ac�c� ��� <�-�-�-� e 0 ql7 7 <br />Proposed Use of Structure/Addition:. C 4AVQ 1 9— <br />?C ?7 <br />Anticipated Start Date: g (Home/Cabin; Commercial Business; B•edrpom; Deck; etc. <br />I q1 7 pW, <br />Building Contractor: Pve've ,a e Sewer Installer: �u e v 41C,,r <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />�I S Sa� o �O� 5 I� e, Yv)Ovo <br />1 0V <br />ll // <br />Date of staffi e vi / Initials f site staff: <br />st visit: i1t. � taso visit sta s <br />PERMIT APPROVED BY LAND SERVICES OFFICI�T. DAV <br />� <br />UPON APPROVAL: APPLICANT 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 />n <br />NI <br />0 <br />o_ <br />a <br />N <br />0 <br />C <br />-0 <br />r <br />r <br />o0 <br />a <br />L_ <br />J <br />f <br />C� <br />v <br />;i <br />-o <br />`,U o <br />4- <br />0 <br />CDCD <br />Q. <br />X <br />E3 <br />::� I I <br />Fee Rec:« <br />O'k, f j -7 a3 -�), <br />C— <br />C= C <br />r -- <br />f17 <br />C? <br />co <br />