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f <br />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 U3Addition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure ition/Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) ition/Alteration to Accessory Structure $150Accessory Structure (Commercial/Industrial) ition/Alteration to Bunkhouse $150Deck/Stairs/Patio/Retaining Wall/Sidewalkhouse $250 <br />Driveways/ & Campground Structures tate Statute 59.692(1v) Structures $350 <br />Filling/Grading house $500 <br />Six Month Camping Unit (One Per Year) it 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: 4,0 r / <br />Property Owner's Mailing Address: O � S� <br />City State Zip <br />Property Site Address: Z O Lt et i Rv.►..ej Lic if52 <br />Contact's Telephone Number: ? CS"—m ? %— 7 <br />lori hom 6)eu.14A fart-nQ-rS ,Cor-% <br />Contact's Email: � a a , <br />Legal Description of Property: P e 'L Q QV 16 rJ / ! a <br />Section #: Town #: -A -7 N Range #:_2_W Town of: I'LL Cj <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/Addition: <br />Anticipated Start Date: / (Home/Cabin; Commercial Business; Bedr D ck; etc.) <br />Building Contractor: E ��" Sewer Installer:! Jl�s �-�►� <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />dn,� <br />Date of staff site visit: Initials of site visit staff: <br />� la�lJ <br />PERMIT APPROVED BY LAND SERVICES OFFICIA • ed4=l DATE: <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 />C3 <br />0 <br />0 <br />DIP <br />0 <br />H <br />n' <br />d <br />m <br />Fee Rec: <br />5�u <br />