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,t <br />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 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: ' t4 �r -.1 1A, C— � ,' O—, S iM r i 'L+ S, cJe.J qw)4 �• <br />Property Owner's Mailing Address: Li t , Q . izp,.t wn t,QX <br />City State Zip <br />Property Site Address: <br />Contact's Telephone Number: -7 U 3 -7 3 L- .-_ 1�, G 3S <br />Contact's Email: A-rr-t4 L <br />Legal Description of Property: L,4 •} H t= T 1'ZW- ciL (A kc- 61'i i+ -i te5 LCs % <br />Section #: Town #:_3_) IJ N Range #: W Town of: j %Ar <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): <br />Proposed Use of Structure/Addition: e v ; l �� 3�x 7 O <br />Anticipated Start Date: 9 Z 7 (Home/Cabin; Commercial Business: Bedroom; Deck; etc.) <br />Building Contractor: INJ0It- k --` Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Date of staff site visit: Initials o site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICI DATE: g <br />UPON APPROVAL: APPLICANT ST 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 />r <br />a <br />