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LAND USE PERMIT APPLICATION — Burnett County, WI <br />A" -'b C'Oi31ji ` i'il -Se0fions B 10 W: 1$ Lliie <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 />1� 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 I Bunkhouse $250 <br />Driveways/ & Campground Structures $125 jW1 State Statute 59.692(ly) Structures $3S0 <br />Filling/Grading $150 1 lBoathouse $500 <br />Six Month Camping Unit (One Per Year) 1$1001 1Permit Extension (1 Year Extension - Al lowed 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: &M / 2AtBali" <br />Property Owner's Mailing Address: PI) to 3 q go' <br />Property Site Address: 1{j�1-! 3,Qm�-[Q�J �State Zip <br />D� <br />Contact's Telephone Number: IS •- 5 a0 —Q a 3 F� <br />Contact's Email: 0 -CL M <br />/rY-��Lt KZI!�t(` i A -d * C.�^Al <br />Legal Description of Property: zj ©"ttt'D.'��/A f p-� (29M mo -0:0- i <br />Section #:�3 Town #:�N Range #: W Town of— /C <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): Lo 30A <br />Proposed Use of Structure/A diti ka 3 4 x <br />Anticipated Start Date: 9 t;91 $ (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor,—Tokn soo Sewer Installer: <br />SERVICES- STAFF CU M .ENTSIC0NDM, QAT&+FIO!I LY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />/414e, 5 t(ye §1' Ulla4' q11 6101 <br />I #6 rea r C� eS �J /""gf // 4 <br />IVo74 7Zr la c L(i je; l- 4 L^A cc <br />/Voe4 S eAwe,1- Ve6040ec7�evwl i'f i'f Pl y,^'► �1 N� ih flie. <br />Date of staff site visit: 9 1 Z Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: <br />T o� F� �wM <br />e-,3� vF� ge <br />1 of 4 <br />pt f 7/103, Burnett County, WI Land Use Application — Rev 3/2018 <br />r <br />a � <br />h � I <br />H <br />>v � <br />'�O o <br />G7 n' <br />°< r- <br />cz, (� <br />b b' <br />� S <br />z <br />o <br />ITI <br />o <br />m C7 <br />4 <br />O H <br />CD <br />a <br />0 00 <br />o <br />m <br />n, <br />C4 <br />o w <br />y <br />�J - <br />W <br />z <br />� 0 <br />s. Fee Rec: <br />rV <br />O C`v <br />co <br />