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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 jW1 State Statute 59.692(1v) Structures $350 <br />Filling/Grading $150 Boathouse $500 <br />Six Month Camping Unit (One Per Year) $100 jPermit 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: f k 15�- <br />Property Owner's Mailing Address: 610 -al PtMDU l N • 6eI d,,, V AAZ j: d-77 <br />//` /� City State Zip <br />Property Site Address: 0-0 ��l �j'iG �OLq d!! E 611,111-fl-41zni WX S�1�8yo <br />Contact's Telephone Numbe�/r: / a S' 6 — 7S l S <br />Contact's Email: ac�t 4 <br />Legal Description of Property:L�f <br />Section #: r D Town #: 7 N Range #: / S W Town of: %y �'; Z wle <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):_), 3-7 3., &20 <br />Proposed Use of Structure/Addition: (j U L- koif de 4 <br />Anticipated Start Date:{' ,Q (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: Sewer Installer: /✓ h <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Date of staff site visit: / ' Initials of site visit staff - <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL• DATE. <br />UPON APPROVAL: APPLICANT MajVT 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 />Ir <br />0 <br />0 <br />71 <br />0 <br />b <br />y' <br />5. <br />o x <br />w <br />z LA <br />� rt-- <br />�c <br />H Fee Rec: <br />M <br />ry <br />Q <br />ce <br />