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LAND USE PERMIT APPLICATION — Burnett Countv, WI <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure <br />$300 <br />Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure <br />$300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />-� Accessory Structure (Garage,'Shed, etc.) <br />$150 <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) <br />$200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Driveways/ & Campground Structures <br />$125 <br />Bunkhouse <br />WI State Statute 59.692(ly) Structures <br />$250 <br />$350 <br />Filling/Grading <br />$150 <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />Permit Extension (i Year Extension - Allowed Once) <br />$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 not listed above will be treated as accessory structures, such as: pergolas, laqdSgaping, etc. <br />Property Owner's Name: <br />Property Owner's Mailing Address <br />Property Site Address: L1 Z <br />Contact's Telephone Number: <br />2 - <br />Zip <br />Contact's Email: e*r e.a ('raQ t . (-Dyy-� <br />CJ <br />/� <br />a <br />Legal Description of Property: DOV- t � _ �-Oxmsieci_j Qt�t> L� � q <br />Section #: CJ O 'Z- Town #:.J q N N Range #:1�110 W Town of: 61, f Cin ©Y1 <br />*Attach additional page if needed for lengthv description OR attach a copy of the deed OR attach tax system propertj, page.* <br />Tax ID # (1-5 digit number; found on tax statement): 2iG <br />Proposed Use of Structure/A¢Yditiyh . S�IEb <br />Anticipated Start Dater <br />Building Contrac <br />(Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />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 sit visit staff: <br />PER -MIT APPROVED BY LAND SERVICES OFFICIAL: <br />UPON APPROVAL: APPLICANT MUST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Page I of 4 <br />Burnett County, wl Land Use Application — Rev 3/2018 <br />7 <br />I <br />77D <br />y� <br />x <br />O <br />-i Fee Rec: /Of <br />�3t? <br />