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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 />ASory Structure (Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br />eck/Stairs/Patio/Retaining Wall/Sidewalk IBunkhouse $250 <br />Driveways/ & Campground Structures $125 IWI State Statute 59.692(1v) Structures $350 <br />Filling/Grading $150 Boathouse $500 <br />Six Month Camping Unit (One Per Year) $100 Permit Extension (1 Year Extension - Allowed Once) $100 <br />*NOTE: After -the -fact permits (permit aquired after construction has begun) may cost up to three times the normal fee. <br />*Communication Towers & Signs require a different application form; see corresponding application, and fees. <br />*Items not listed above will be treated as accessory structures, such as: pergol s, landscaping, etc. <br />Property Owner's Name: <br />Property Owner's Mailing Address: <br />A146 <br />State Zip <br />Property Site Address: <br />Contact's Telephone Number: <br />Contact's Email: dvu <br />qzlCSM <br />.,) �^ / 1 <br />Legal Description of Property: �i>f � (.S 1 V �$P�� ��t /C17%Z �r" 39/ � l <br />Section #: Z.t 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 />Tax ID # (1-5 digit number; found on tax statement): <br />Proposed Use of Structure/ddition:&�T LJ ae. <br />Anticipated Start Date: iii (Tlonze/Cahin; CommercialBusiness; Bedroom; Deck; etc.) <br />Building Contractor: (Yj/y 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 />ARerzv. //,,,, , S. �-c V' `,,/- 6-. <br />PTROVED -- (r6o <br />no <br />Date of staff site visit: O l V Initials of si a "sit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL:2 DATE:9-/.f-zg <br />UPON APPROVAL: APPLICANT MUST 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 />m <br />0 <br />0 <br />0 <br />N <br />0 <br />0 <br />5' <br />ro <br />C7 <br />4 <br />914 <br />LL' <br />