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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 $3001 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.) 1 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: L N11W)\ e101 <br />Property Owner's Mailing Address: <br />�^ r / Ci State Zip <br />`C <br />Property Site Address: VJ � ve-10 i Yl —� r/� <br />Contact's Telephone Number: <br />Contact's Email: <6kL�Q f �e <br />_o. <br />Legal Description of Property: Z --Ip ]L 2— CSS 14, 01 4 Z6�_ Z' <br />/ J ` <br />Section #: ? 6 Town #:_�N Range #: 1� W Town of: c 0`( <br />*Attach additional page if needed for lengthy description OR attach a copypof(t�he deed OR attach tar system property page. <br />Tax ID # (1-5 digit number; found on tax statement): 31 �D O <br />Proposed Use of Structure/Addition: PI" ks L, s <-- <br />Anticipated Start Date: (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COM-NIENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />la I%�ft <br />AirMOVED <br />o_s 51c, �) tC,,-+,c51 <br />Date of staff site visit: Initials of site visit staff: <br />6 I <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL:6,LDAT <br />UPON APPROVAL: APPLICANT Mtk 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 />_ <br />a <br />s� <br />_ <br />b <br />c <br />G <br />a <br />X <br />d <br />.1 <br />Fee Rec: 5_0 <br />-9�! <br />elke 201TO <br />