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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 I 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) 1$100 Permit 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: Da y -i A J' K -S leis KA V <br />Property Owner's Mailing Address: 42 ek.,tn I7)ry <br />City State Zi <br />a%� <br />Property Site Address: xo Sr%L4ddiq Rcl r, ^k� w= Sy 'YO <br />Contact's Telephone Number: f, 12 - 3 a s' ' 4 to Z y <br />Contact's Email: AOL J . n . ye It Y � cx;ylcL i � • C �� <br />Legal Description of Property: $(t, �y elr 4,C N COLI ,, Sum, T3 %, R /,74/ i <br />Section #: i5, Town #:_31_N Range #: W Town of. ( JZS f %�iArA la n q <br />*Attach additional page if neededfor 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): % IT 7 <br />Proposed Use of Structure/Addition:t Sh C d /90pag e - <br />Anticipated Start Date:/O 'a%Z —1 6 c�'(Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: P C Z Pct e 13 o: lc1 i n as Sewer Installer: Al A <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />7i HIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />n 1� <br />o—' <br />Date of staff site visit: Initials of site visit staff: <br />PERMIT APPROVED BV LAND SERVICES OFFICIAL DATE <br />UPON APPROVAL: APPLICANT MST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: - Page I of 4 <br />Laserfische: - Burnett County, WI Land Use Application — Rev 8/2018 <br />N <br />0 <br />2 <br />�o <br />W <br />d <br />30 <br />Fee Rec.s� <br />Check #: 571 It <br />0 <br />m <br />a <br />r <br />C= <br />co <br />0 <br />b <br />