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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 1 X 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 1 jWl State Statute 59.692(1v) Structures $350 <br />Filling/Grading $150 1 jBoathouse $500 <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. <br />*Communication Towers & Signs require a different application form; see corresponding application, and fees. <br />*Items not listed above will be treated asaccessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: ,/7h 0/re W and (� ri s i-ivi , ca L Ic S o r1 <br />Property Owner's Mailing Address: 97 7'7 `� Lee t�c� �ilJg�lf e✓ �?iI Sy8 3 <br />Property Site Address: '?710 C O Ltnfy City State Zip <br />Contact's Telephone Number: 7/Y,- '733 020S <br />Contact's Email: 14761-,ewi'l I u cksc`r 6 cam' aj rKa-1 <br />Legal Description of Property: L, (' t �2 e4 L SM /90. 4107 roll 'Ytt <br />Section 4:-0, q Town #: yO N Range #: 15 W Town of: q C kS On <br />*Attach additional page if needed for lengthy description OR attach a copy of the deea OR attach tax system property page. <br />Tax ID # (1-5 digit number; found on tax statement): S% 0C) <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: /O - / 9 0 1 $(Home abrn; ommercral Business'; Bedroom; Deck; etc.) <br />Building Contractor: ZSre�j* Pct.^44,, Sewer Installer: A 'h' / <br />-X-A s -Ac tf&W Sep : c <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />1APPROVID <br />Date of staff site visit: Initials of site visit staff: U <br />PERMIT APPROVED BY LAND SERVICES OFFICIADATE: <br />�_�_, o <br />UPON APPROVAL: APPLICANT M T 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 />0 <br />0 <br />n <br />r <br />b <br />a <br />W <br />A <br />00 <br />TL <br />to <br />--iFee Rec: <br />d <br />