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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 1 jWl 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) IS100 <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: ko /7 )eslizzle, <br />Property Owner's Mailing Address: 12,/; > ZAI 1 ;' i MnXN; <br />��� i t �� <br />Property Site Address: i c � � ,' City State Zip <br />Contact's Telephone Number: 7/S •% ?d 7'&7'j <br />Contact's Email: A o Vile, Gu) t (� 5rlryh 'jV ,-)7 j <br />Legal Description of Property: /of o� G,Sn J t1 / G 7a;t Zr I I h 1!5 1V /01,?) <br />Section #: -3 iK Town #:_10 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 propertypage. <br />Tax ID # (1-5 digit number; found on tax statement): � <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: Ir (/ (Home/Cabin; Commercial Business; Bedroom Deck; etc.) <br />Building Contractor: _ O led,4A Sewer Installer: Y <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: 15 - 110) — T11, Initials of si a visit st f: i <br />f . <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: ATE: g- d • �� <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 />Fee Req:.)�it✓ <br />65 C <br />°�e�T i 3e osvS�r <br />ro <br />0. <br />CD <br />a <br />G <br />w <br />0 <br />O <br />1 1 <br />VV <br />a <br />� <br />ro <br />�7 <br />°0 <br />/� l <br />(' / <br />7' <br />z <br />o <br />o r <br />"4 <br />d <br />w <br />a' <br />� <br />o <br />o <br />a <br />I <br />0 <br />oa <br />G <br />o <br />E <br />Fee Req:.)�it✓ <br />65 C <br />°�e�T i 3e osvS�r <br />