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r <br />LAND USE PERMIT APPLICATION — Burnett County, WI ¢ G' <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate boxes) J <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 1 jWl State Statute 59.692(1v) Structures $350 <br />Filling/Grading $150 1 Boathouse $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: �tkrll 44 'a ClercI d " n'- <br />Property Owner's Mailing Address: N W-52 :39' �� zn on )dni'Q- W, ¢7S1 <br />/ /� City State Zip, <br />Property Site Address: 6 (e,:* .L"7kp. r T)tk <br />Contact's Telephone Number: -1 t 5-- 2 3 - 60 -785 <br />Contact's Email: Y rn % (0 2A tj oLhoc • Ctrs--% <br />Legal Description of Property: 5a— a, F4 -&C CJKrY% t ^J' <br />2 s� <br />Section #: J Town #:-jACV-SVhN Range #: W Town of: �ii C SL`T1 L eh n <br />v— <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. <br />Proposed Use of Structure/Addition: CA -6 -' <br />Anticipated Start Date: / agr 21,x) S (Home/Cabin, Commercial Business; Bedroom: Deck; etc.) <br />Building Contractor: 6w)n Q.r )-EN Oi'ZI It50Oi Sewer Installer: y Q -C iL50r-) -!�;e Qp'>t"t L, <br />AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERLMIT IS SUBJECT TO j�ALL CONDITIONS LISTED BELOW: <br />- U3`1 C'D� 7 oL\ `n s ��e OLX d� e 5 S ���JY� 6-V c <br />9130 APPRU^VED <br />LaLC Vl JLall 3 tt: V a. 1111L1a1J V1 J1LC V131L 3L411. <br />PERMIT APPROVED BY ZONING OFFICIAL-,jDATE) <br />UPON APPROVAL: APPLICA /MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Page 1 of 4 <br />Burnett County, WI Land Use Application — Rev 1/2018 <br />n <br />0 <br />0 <br />Fee Rec: <br />Y <br />G <br />w <br />x <br />d <br />W <br />