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LAND USE PERMIT APPLICATION — Burnett Countv, 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(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 aqui red 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: A p ikc—E <br />Property Owner's Mailing Address: <br />City State Zip <br />Property Site Address: iC) l3Av, �` C 7 6- le <br />Contact's Telephone Number: �-�2 -7 54' J - ( <br />Contact's Email: ? p fJ h G— E n t S Al . c- G ))'i <br />Legal Description of Property: ' sc-e k � v, G a u' <br />1 -F LO "( a <br />Section #:Q3 !7 Town #: 0 N Range W Town of:�-:� 0— CKSOYI <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): SS63 <br />Proposed Use of Structure/A dition: C' o_Ya�. e <br />Anticipated Start Date: SOOK 0.-S ( me/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />E.Yvv.� <br />Building Contractor: 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 />'PROVED <br />Date of staff site visit: �— ri 3 " �� Initials of ' visit st <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: <br />UPON APPROVAL: APPLICANT MUST 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 />14,0/50 <br />Fee Rec:_ <br />0 <br />m <br />