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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(ly) 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 />1 <br />Property Owner's Name: <br />Property Owner's Mailing Address: r og to ® 5q go <br />C9 <br />" � f n _� City State Zip <br />Property Site Address: �] l y rhe 9 (�(c� M tl,�dyC- <br />Contact's Telephone Number: 5 aO+— La 3 "cCi� <br />Contact's Email: (� -C yYl/rY_��U i[GuaQ,� VI t)fMj/��h�,(y CZ^A�, <br />Legal Description of Property: l lam► I Aj Q�01 % p -F c5m ft�ao I I J ,�k <br />Section Town #: 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 property page.* <br />Tax ID # (1-5 digit number; found on tax statement): ko 3�A ( <br />Proposed Use of Structure/A diti 5 ko a j 0 X j 6 <br />Anticipated Start Date: q `��) (Home/Cabin; Commercial Business; Bedroom: Deck; etc.) <br />Building Contractor:, -i\ -41 1I / voc-,Oo Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />1V491-1- ON <br />PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />/V 49/C� �e US / �Ja a"I 414 4)Qll <br />Date of staff site visit: I Z 'a Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: <br />UPON APPROVAL: APPLICA T MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />/ f <br />1p7wo vl1P� i5 1'33 � f 19m � oT�lJ7�r, �w Page 1 of 4 <br />Burnett County, WI Land Use <br />// r, <br />Q/ f 0 10"h' Application — Rev 3/2018 <br />