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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 <br />$300 <br />Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure <br />$300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />x Accessory Structure (Garage, Shed, etc.) <br />$150 <br />I <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) <br />$200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Driveways/ & Campground Structures <br />$125 1 <br />Bunkhouse <br />jWl State Statute 59.692(1v) Structures <br />$250 <br />$350 <br />Filling/Grading <br />$150 1 <br />lBoathouse <br />$500 <br />Six Month Campine Unit (One Per Yen rl <br />5100 <br />Permit Extension (1 Year Extension - Allowed Once) <br />15100 <br />*NOTE: After -the -fact permits (permit aqui red 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: <br />Property Owner's Mailing Address: <br />Property Site Address: <br />15 syz 6 <br />State Zip <br />Contact's TelephoneC! �/Nuumber: /9 <br />Contact's Email: x1)a15,z4.0 7`0"/ !/4e (U/9.(L._/'/J]& *. CG�� <br />Legal Description of Property: L CJ t /e 5 A"_7 <br />rr.�n �5Ac <br />Section #: Town #: N Range #: % 7 W Town of TRG KS a- /I <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/Additi?n: P122- m }alp Ut/ �t '�/ J�►►�Q ��r+�°/n'"AnSSe') 5 <br />Anticipated Start Date: eil (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: <br />Sewer Installer: Ald <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LK ED BELOW: <br />1 <br />Date of staff site visit: I- I J ` ) Initials ofit visit sta <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: <br />TER -13 - <br />UPON <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 />C VVV <br />r� rp <br />0 � <br />y <br />E3url <br />le <br />W <br />Q <br />ro <br />7 <br />o <br />S <br />r <br />C <br />CD <br />z <br />P <br />� <br />C <br />0 <br />a. <br />b <br />(n <br />Q <br />N <br />c <br />O. <br />d <br />o <br />ado <br />U <br />d <br />5. <br />n <br />o <br />� <br />ra <br />Fee Rec: <br />tp <br />r� rp <br />E3url <br />p <br />ro <br />