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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 1 jAddition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure $300 1 lAddition/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 IBunkhouse $250 <br />Driveways/ & Campground Structures $125 1 jW1 State Statute 59.692(ly) Structures $350 <br />Filling/Grading $150 Boathouse $500 <br />Six Month Camping Unit (One Per Year) $100 jPermit 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: kl`a1 -: 9614 <br />Property Owner's Mailing Address: f A L43 C(12� N� SS /y f <br />City State Zip <br />Property Site Address: z%z�� l� FS> C t PS.; 7T <br />114 l <br />Ci State <br />Uj) <br />Contact's Telephone ,Nuumber: a 2^ Plo -- 6 30 <br />Contact's Email: e,<f I A t &12OV9 eo fiap }Vi Dfc�. COQ <br />Legal Description of Property: <br />Section #: Town #:�3N Range #: I`i W Town of: <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br />Tax ID # (1-5 digit number; found on tax statement): — <br />Proposed Use of Structure/Addition: Vf - CV4- S- Zf )y r, I O X a <br />Anticipated Start Date: LILqUS f- (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: ADA�1 (tel IrJ(, 2 Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />)�- �� 0.-V1 - see varJq>^CP, ' VAA-'8-0� <br />Date of staff site visit: Initials of site visit staff - <br />PERMIT <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: $ a <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 />Na <br />o cra <br />d <br />o <br />y <br />� <br />x <br />-� <br />3 <br />� <br />� <br />N <br />O <br />z <br />-i Fee Re c�7S0 <br />c�c-99-7-7 <br />a <br />b <br />