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If <br />LAND USE PERMIT APPLICATION - Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />�yr <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure $300 Addition/Alteration to Commercial/industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) $150 Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) $200 Addition/Alteration to Bunkhouse <br />$ <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(1v) Structures <br />$250 <br />0 <br />Filling/Grading $150 Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) Isloo Permit Extension (1 Year Extension - Allowed Once) <br />$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: -- I f'G rt Qn(2 <br />Property Owner's Mailing Address:. ' �- <br />+� City to Zip <br />Property Site Address: i' (tel � �• �' �7 IL { 1 <br />Contact's Telephone Number: <br />Contact's Email: ni � � ►7'1CL`�'f^. _ Gar c -n CF. C ci—r) <br />Legal Description of Property: LO t 1 4- IU I c� �C ` JE VISI' i"4kCk- <br />Section #: _ Town #:40N Range #:I-L7_W Town of - <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): <br />Proposed Use of Structure/Aidditio LAkC 1k1a- ( <br />Anticipated Start Date: ��i� (Hone/Cabin; Commercial � usiness; Bedroom; Deck; etc.) <br />Building Contractor: --T—f5 -D 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 />— M,sf Me-� -Yl/ f�gCs q 5 rf-Y(4,'4ecl 6 y VC? rlGl1ce__ <br />V14A - 1-2- /0. <br />kou S--- � <br />Date of staff site visit: <br />Initials of site 'sit st _ <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: - <br />�& <br />DATE: <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Page 1 of 4 <br />APPROVED Burnett County, WI Land Use Application — Rev 3/2018 <br />r <br />b <br />00 <br />N <br />O <br />5 <br />INCUR <br />IN <br />-� Fee Rfc:,550 <br />!, 11ecK#// 533 <br />m <br />C= <br />�yr <br />a <br />o <br />N <br />Q <br />m Co <br />M <br />IF <br />