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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 />ec Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br />Driveways/ & ampground S ructure $125 WI State Statute 59.692(1v) Structures $350 <br />Filling/Grading $150 Boathouse $500 <br />Six Month Camping Unit (One Per Year) $100 1 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:Y <br />Property Owner's Mailing Address: l�2 1 � �� S _� �+ i <br />n • City State Zip <br />Property Site Address:�)� 1 0 I� ��� (' (� `) 1 La l Z x <br />Contact's Telephone Number:i t s - Sad-. - C-') c7 5- =2,r n s-1 <br />Contact's Email: - �V\k A.y6-1 n Ca����-(`' C(( /I ` .C, ofYA <br />Legal Description of Property: 1L r) I :� % i E,-/\, �N I' (9 n 'S -\'V r� w) <br />Section #: Town #: N Range #: W Townof. <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): 1 1-!L4 0cl, <br />Proposed Use of Structure/Addition: I�k, <br />Anticipated Start Date: J(Home/Cabin; Commercial Business; Bedrooni; 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 />L"�ICr,12 V r1 <br />Date of staff site visit: `y Initials of sit visit staff: <br />C � 1 <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: r <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 />