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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 (1Year 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 Named ✓ �� G w ^ <br />Property Owner's Mailing Address: 6� ` �C ' Ct ,f-4 <br />tCity State Zip <br />Property Site Address:_Q a?/ <br />Contact's Telephone Number:> t' �( - 0&a <br />M <br />Contact's Email: Co- <br />-P <br />T.egal Description of Property. <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): l / - <br />Proposed Use of Strue ture/�i)on <br />Anticipated Start Date: cy/ldr' (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: JC3 �,- .s Co 10-1 Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL <br />rt CONDITIONS LISTED BELOW: <br />5 L c,a k[n <br />e r v u 3- � 5 o b k&_Ny-,c- A'a vv-� o- ke Q_ --le") s 4Ain <br />L 6-6 Nr� LoY­�-q� A0 Ae� <br />,00 .so. I<�> <br />Date of staff site visit: Initials of site visit staff: <br />a?_ <br />PERMIT APPROVED BY LAND SERVICES OFFICI )"'jDATE: �\ ` /? <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 />C <br />a <br /><� <br />C <br />r <br />b <br />a <br />U1 <br />A <br />O <br />n <br />pu0 <br />w <br />-o <br />r <br />0 <br />z <br />0 <br />^7 <br />o <br />c <br />a. <br />a <br />d <br />N <br />c <br />'o <br />oc <br />B' <br />b <br />n' <br />o <br />� <br />� <br />x <br />E7 <br />1 <br />a� <br />- <br />Fee Rec:3 S b <br />MORE <br />hWl <br />