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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 Bunkhouse $250 <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(ly) 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: (Ilyo ti e_8 o Iii <br />�j T pp <br />Property Owner's Mailing Address: fi dJ'LA bwyIS 0 <br />p, t� City State Zip <br />Property Site Address: ©� �� ue rry D G't ►a �(,( i�l� W � S 3C> <br />Contact's Telephone Number: <br />Contact's Email 42 rne SCI ,drl nfM G k On - <br />Legal Description of Property: 2 CS t• t 0•-1 Q <br />Section #:19 Town #:�N Range #: % % W Town of: -jock1 A <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): '3Z81 <br />Proposed Use of Structure/ddi i� , U n C o roti 9— <br />Anticipated Start Date: (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: }yl Sewer Installer: <br />AREA BELO`Z' THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />V6 �' a"j �J �-S y -a ► av, C, C_ co n j <br />Date of staff site visit: J Initials of site visit staff: <br />1 <br />� <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATV: <br />UPON APPROVAL: APPLICANT M T 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 />CIO <br />0. <br />O <br />O <br />0 <br />a <br />d <br />N <br />c <br />5' <br />0 <br />2 <br />Che c %# <br />