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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 I Bunkhouse $250 <br />Driveways/ & Campground Structures $125 jiWl State Statute 59.692(ly) Structures $350 <br />Filling/Grading $150 1 lBoathouse $500 <br />Six Month Camping Unit (One Per Year) $100 1 1 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: ' k Ar em <br />� - h_Alp r ( I, .j <br />Property Owner's Mailing Address: v- <br />/ C State Zip <br />1 9 / ��VE' <br />Property Site Address: VU L IAC. ®ie ��UF.t` wi_,:r�(�_� <br />Contact's Telephone Number: 7�_���/- Q?•�j/ 3 <br />Contact's Email:��T10 y.� " ens ,014- <br />Legal Description of Property: 4 a t QS- &10 L/ ze <br />Section #: Town N Range #: W Town of: 5GD <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): /% 9 o1 % <br />Proposed Use of Structure/Addition: - - f .`Q q �e —�; 4 ,e j <br />Anticipated Start Date:—A (Jq , O ome/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: ��+M�(' bm 0n 9 q � Sewer Installer: 1 V�. <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS ,PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />MUj S t k C-1- )0/ �� A,rcl,\ ItJ &--- <br />Date of staff site visit:z : � Initials of ite visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: 6dA DATE. <br />UPON APPROVAL: APPLICANT MU 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 />N <br />c <br />0 <br />n <br />o <br />r <br />0 <br />n <br />r <br />o <br />G <br />9 <br />r; <br />d <br />b <br />v� <br />Ln <br />k <br />� <br />C7 <br />d <br />z <br />r f C <br />Fee Rec: <br />