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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 <br />$300 <br />Commercial/Industrial Structure <br />$300 <br />Accessory Structure (Garage, Shed, etc.) <br />$150 <br />Accessory Structure (Commercial/Industrial) <br />$200 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Driveways/ & Campground Structures <br />$125 <br />Filling/Grading <br />$150 <br />Six Month Camoine Unit (One PerYear) <br />5100 <br />Addition/Alteration to Dwelling/Principal Structure <br />Addition/Alteration to Commercial/Industrial Structure <br />Addition/Alteration to Accessory Structure <br />Addition/Alteration to Bunkhouse <br />Bunkhouse <br />WI State Statute 59.692(1v) Structures <br />Boathouse <br />Permit Extension (1 Year Extension - Allowed Once) <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: `) U U <br />Property Owner's Mailing Address:�� <br />Property Site Address: <br />I9 N. 84.TIE-y Ru. <br />Contact's Telephone Number: ? 15 - 1� I , - D 9 5 l <br />Contact's Email: <br />c' <br />V <br />$200 <br />$200 <br />$150 <br />$150 <br />$250 <br />$350 <br />$500 <br />$100 <br />N, ve y W I � v,?30 <br />City State Zip <br />Legal Description of Property: P C L. S E N-�F- <br />Section #: ILP Town #:--LLO N Range #:_1W Town of: LI , I () N <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): t2-9 C� S <br />Proposed Use of Structure/ <br />Anticipated Start Dater <br />Building Contractor: <br />Sewer 4ns4l4e,r : <br />less; Bedroom; Deck; etc.) <br />31C-A++-?1U14)�, <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: q-7—/? Initials of si a visit staff- -.5z. <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Page I of 4 <br />Burnett County, WI Land Use Application — Rev 3/2018 <br />C" <br />b <br />o3 <br />O <br />F <br />1A <br />L <br />Y Fee Rec: J(JV <br />Ln 00-s� <br />m <br />m <br />n <br />n <br />c <br />� <br />a <br />P4 11P <br />r <br />C=-e <br />rV <br />nO <br />d <br />