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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 $3001 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(1v) Structures $350 <br />Filling/Grading $150 Boathouse $500 <br />Six Month Camping Unit (One Per Year) $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: 'F -,p 11 A"V Vj�tLj� K tZt S q <br />Property Owner's Mailing Address 'S CC;l MC --V- E../ i <br />City State Zip <br />Property Site Address: Ima S1rK,> <br />Contact's Telephone Number: X05i-S11;- R t a� <br />Contact's Email: R 1<r t — — wK w\ c;.ov-\ <br />Legal Description of Property: iQ - Lf ©- H PC -4- &i- l (i -CIT- V7) <br />Section #: 10 Town #: LI b N Range #: 144 W Town of: 5 C.617-- <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): 17 Be ; <br />Proposed Use of Structure/Ad ition;;j, (16' X 3d) —2:a6v; ICJ <br />Anticipated Start Date: IUci 'tc>( (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: d -e How�c.e, Sewer Installer: AIIA <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 site visit staff: <br />Z <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL• DATZE 2 <br />1 <br />1:P <br />UPON APPROVAL: APPLICANT MUST 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 />O <br />d <br />O 'f— <br />z �. <br />r <br />Fee ReAlQ5_ <br />Check <br />Ckskaw, o'�eCC <br />