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LAND USE PERMIT APPLICATION — Burnett County, WI g r <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Please,check appropriate boxes) d �w <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 OQ <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 /> G) � <br /> XDeck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 r <br /> Filling/Grading $150 1 113oathouse $500 0 <br /> oo <br /> Six Month Camping Unit(One Per Year) $100 1 lPermit 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. S <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. ro <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z k Property Owner's Name: ,K0 h 0 <br /> Property Owner's Mailing Address: 6399 1 0 cLy 1,s cl rE. <br /> City State Zip <br /> Property Site Address: 63 q 8) CL y Ll h&%,Ael- <br /> Contact's Telephone Number: 2n a <br /> W r7 <br /> Contact's Email: -to n U(y x a✓(g vK c 'n L'7 rit <br /> Legal Description of Property: L 9T 4-j CS#-A ✓i 3 J)10 3.7 6 851) Al IV," E + ,S LV <br /> Section#: Town#: N Range#: 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 /> a <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: 0eG (( O -X a 0 o <br /> Anticipated Start Date: (Home/Cabin,,Commercial Business;Bedroom;Deck;etc) <br /> Building Contractor: Sewer Installer: y 3; •-- <br /> � r— <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY --V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: j P <br /> 0 <br /> Fee Rec:�/-?6-01 <br /> d <br /> ( a;Db0 <br /> Date of staff site visit: Initials of site visit staff: r <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: l�'�f z <br /> UPON APPROVAL: APPLICANT M T POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z <br /> r A <br /> -C <br /> Page 1 of 4 <br /> Burnett County, WI Land Use Application—Rev 3/2018 O° <br /> d <br /> a <br />