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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 />XDeck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br />Driveways/ & Campground Structures $125 jWl State Statute 59.692(1v) Structures $350 <br />Filling/Grading $150 lBoathouse $500 <br />Six Month Camping Unit (One Per Year) $100 1 jPermit Extension (1 Year Extension - Allowed Once) $100 <br />*NOTE: After -the -fact permits (permit aquired after construction has begun) may cost up to three timesthe 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: N& S :2n,n 1 & v t &i' <br />Property Owner's Mailing Address: AS E-10 X- PA V L MA :5 -sl 1 <br />City State Zip <br />Property Site Address:Z 8 9 Y a� df CIA'( L,11. <br />Contact's Telephone Number: LSI - S 5 q - 3L3-1 <br />Contact's Email: da J1 Go wt <br />Legal Description of Property: -& 0 ,116 CIA— T L n <br />Section Town N Range #: > W Town of: ICL c K. Sp Y:�,, <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): 5' <br />Proposed Use of Structure/Addition:_ S7 p S j"owv' O 0. k e---, <br />Anticipated Start Date:_ =y _� (Home/Cabin; Commercial Business; Bedroom; 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 />Date of staff site visit: / Initials of ite visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL• DATE: <br />UPON APPROVAL: APPLICANT M 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 />0 <br />0 <br />a <br />m <br />5 <br />0 <br />0 <br />ro <br />d <br />0 <br />m <br />t' <br />b <br />a <br />X <br />d <br />:� I I <br />Fee Re-/ <br />Check #: /s(9 61)� <br />