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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.) 1 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(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: pergolas, landscaping, etc. <br />Property Owner's Name: Q:�k ll t<, C,-�r" <br />Property Owner's Mailing Address: �-� 6 �I l Nr� �` " • �L j 7 2 <br />—7 City _ State Zip <br />Property Site Address: / � l ` l -T C/ ne 7 <br />Contact's Telephone Number: `7 <br />Contact's Email: S�%? S�j?;�Cf�/rl� /GC /}• CIM <br />Legal Description of Property: <br />Section #: Town #:_3_N Range #: l W Town of:�%Pd� <br />*Attach additional page if needed for lengthy description OR attach aacopy of the deed OR attach tax system property page. <br />Tax ID # (1-5 digit number; found on tax statement): -33 2 <br />Proposed Use of Structure/Addition: -ez�(o 2 x <br />Anticipated Start Date: ��� i �� ( <br />Home/Cabin; Commercial Business; Bed r ow Deck; etc.) <br />Building Contractor:/" ct C��1/2 /�(� /! 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 of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: <br />UPON APPROVAL: APPLICANT 4�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 />log <br />W <br />Fee Rec: 5 c) <br />U. <br />U. <br />C— <br />C= C <br />r— <br />N <br />0 <br />O C`�l <br />o <br />