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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 1 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 (1 Year Extension - Allowed Once) $100 <br />*NOTE: After -the -fad 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 notlisted above will be treated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: <br />Property Owner's Mailing Address: ® S 1-o LUCJ- W I <br />I <br />16 S W n _ City State Zip <br />Property Site Address: Y! c a. �, 1'� <br />Contact's Telephone Number: bo 8- 6 9 7-..0 4 y2. <br />Contact's Email: P-POL-k o- &7-P. (- Oy <br />Lecal Description of Property: <br />Section #: 2-7 Town #:---3 2N N Range #: W Town of:7h1h-A Lo4( e - <br />*A ttach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page. <br />Tax ID # (1-5 digit number; found on tax statement): L (0 3 8 <br />Proposed Use of Structure/Addition: G r 3. <br />9 0 - <br />Anticipated Start Date: Ocy I zo ' (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: Stir .1 ✓�a hrag Sewer Installer: <br />AREA BELO`Z' THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />1 j <br />Date of staff site visit: Initials of site Visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICI DATE: )Y/ / <br />UPON APPROVAL: APPLICAN t ST 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 />Cr <br />Q <br />� <br />G <br />C. o <br />m <br />CIO <br />LA <br />O <br />C7 <br />0 <br />0 <br />b <br />0 <br />c <br />G <br />w <br />n <br />cn <br />o <br />N <br />o <br />ao <br />ac <br />C7 <br />to <br />O <br />I� <br />C4 <br />o <br />x <br />� <br />o <br />J <br />Gv <br />z <br />Q <br />Fee Rec: <br />16-0 v <br />R Q <br />M us <br />rn <br />a <br />z <br />n co <br />