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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 IWI State Statute 59.692(ly) Structures $350 <br />Filling/Grading $150 lBoathouse $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: RAmLL S L f{2¢ M <br />Property Owner's Mailing Address: [0( 71 &H I A 57- NI` 6L41'JL It Mr -3 5- S 0 i <br />;;��� City State Zip <br />Property Site Address: 3 $irk tSr°F t^���`-I tn-�E 1�4�LiuR�/ <br />Contact's Telephone Number: 612- - <br />— /-d_1 ' q 3979 <br />Contact's Email: R50 -1,40d(0— G M A'i ( . G O w� <br />Legal Description of Property: Lor 8 of PA,r40p%.1 Pe -•o 400 treepa of VoyAtza- i�I�� z <br />Section #: I Town #:_yQ_ N Range #:__j <br />5 W Town of: JAeKS a j <br />*Attach additional page if needed for lengthy description OR attach a ccopl� of the deed OR attach tax system pmperh, page. <br />Tax 1D # ( 1 -5 digit number; found on tax statement): 1 l <br />Proposed Use of Structure/Addition: 6ygAA(,il- <br />Anticipated Start Date: i — / — f2 (Home/Catrin; Commercial Business; Bedroont; Deck; etc.) <br />Building Contractor: UK ►tr 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 />Date of staff site visit: ! Initials of s to visit staff:�� <br />PEWMIT APPROVED BY LAND SERVICES OFFICIADATE % , <br />UPON APPROVAL: APPLICANT W4 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 />s <br />0 <br />0 <br />5 <br />0 <br />0 <br />n <br />I <br />9— <br />G <br />C <br />N <br />1 <br />V <br />o m <br />y <br />T � <br />Fee RASO <br />Cxec�-# /!38 <br />