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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 $300FAdd <br />tion/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure $300tion/Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) $150tion/Alteration to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) $200tion/Alteration to Bunkhouse $150 <br />ec Stairs/Patio/Retaining Wall/Sidewalk house $250 <br />Driveways/ & ampground S ructure $125ate Statute 59.692(1v) Structures $350 <br />Filling/Grading $150ouse $500Six Month Camping Unit (One Per Year) $100it 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: <br />Property Owner's Mailing Address: �, B , <br />City State Zip <br />Property Site Address:-( —7( j `� } �Q� 1,t ) Z LI 9 7 rA <br />Contact's Telephone Number: <br />Contact's Email: y 1 , <br />Legal Description of Property: Le) U � �� '� � � P 1M }� i� � ,l Y) S\;\j C'tl,+�� <br />Section #: Town #: N Range #: W Town of: : `\ ' 1. <br />*Attack additional page if needed for lengthy description OR attach a copy of the deed OR attack tax systeni property page. <br />Tax ID # (1-5 digit number; found on tax statement): L SL40`li <br />Proposed Use of Structure/Addition: (�t3l�tt" (�- litr k <br />y fl'a <br />Anticipated Start Date: (Home/Cabin; Coiwnercial Business; Bedroom; <br />Deck; etc.) <br />Building Contractor: 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 />411 <br />Date of staff site visit: / Initials of site visit staff: " <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: <br />UPON APPROVAL: APPLICANT MUST 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 />c <br />a. <br />0 <br />Tj <br />D <br />i <br />v <br />A <br />b <br />Q <br />S <br />VN <br />3 <br />rA <br />1M <br />W <br />-3 Fee Rec:-�t a!� <br />