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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 Bunkhouse $250 <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(1v) Structures $350 <br />Filling/Grading 1 $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: <br />Property Owner's Mailing Address: <br />�� P City State Zip <br />Property Site Address: �� � D�� ��/ <br />Contact's Telephone Number: 71- ",2-22- - ZO <br />Contact's Email: he-) 1AI!a lam JIB'' <br />Legal Description of Property: %� l% %2 0 / 1) lat �0 <br />Section #: P7 Town #: N Range #:-437_W Town of: 1"y ,/% V& <br />*Attach additional page if neededfor lengthy description OR attac/ha 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: <br />Anticipated Start Date::- (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: IWAI,#Ao, 64AA IO& "' 1 Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THISS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />lv <br />Date of staff site visit / Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIA DAT : g <br />UPON APPROVAL: APPLICANT MU 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 />S <br />C <br />00 <br />70 <br />^ <br />° <br />o <br />` <br />V- <br />O <br />a <br />cn <br />_• <br />m� <br />° <br />z <br />C— <br />o <br />o <br />° <br />0. <br />^— <br />�Y <br />6 <br />^ <br />o <br />7 <br />c <br />¢ <br />o <br />° <br />0' <br />N <br />q <br />ro <br />v <br />� <br />X <br />7 <br />� <br />o <br />� <br />U- <br />� <br />�r <br />