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LAND USE PERMIT APPLICATION — Burnett Counter, NVI <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure <br />5300 <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 Wail/Sidewalk <br />Bunkhouse <br />$250 <br />Driveways/ & Campground Structures <br />$125 <br />WI State Statute 59.692(ly) Structures <br />$350 <br />filling/Grading <br />$150 <br />1 <br />Boathouse <br />$500 <br />Six Month Camping Unit (One PerYear) 1$1001 <br />PermitExtension(IYearExtension-AllowedOnce) <br />$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:— �t i I14nJ� ST'OL&-jCsA1 ___.__-_ _ - -- <br />Property Owner's Mailing Address:---7DU (ft uf,-4-C ---AJe ._ MA.( <br />City State Zip <br />Site Address: L{G �% I7utR r4r t �f'}"�lfl�f _.A Ws— �7L _Afk <br />Contact's Telephone Number: (o%g <br />Contact's Email:_ eS`.Ist,! ,Ci►+�+ <br />G� <br />Legal Description of Property: CUT_ 3 / �S 3(8 _.� _''''' t l� L-IreS f <br />Section #: Town #: N Range #: W Town of: -%� �t��7"C <br />-A <br />*.4ttach 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 taxi/ statement):. ____ ._ <br />Proposed Use of Structure/A dition: CG_l�cec� <br />Anticipated Start Date: G __ (HomelCabtn,: Commercial Business: Bedroom; peck etc.) <br />Building Contractor: 5&74Joc _ _— Sewer Installer:_ <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF CON'INIENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />De-t:k, is qo oywm <br />Date of staff site visit: Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DA FL: <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 />0 <br />I� <br />6A <br />Fete -Rec: <br />v C--- <br />/Z <br />`v <br />W <br />W <br />04 <br />p0 <br />5D 3 v- <br />