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LAND USE PERMIT APPLICATION - Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />s <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 />Bunkhouse <br />$250 <br />iveways/ & Campground Structures <br />$125 <br />IWI State Statute 59.692(1v) Structures <br />$350 <br />11 <br />F ling/Grading <br />$150 <br />Boathouse <br />$500 <br />jXkk <br />Month Camping Unit (One Per Year) <br />$100 <br />1 <br />jPermit Extension (1Year Extension - Allowed Once) <br />$100 <br />NOT : A er-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: Ao <br />- ,j <br />Property Owner's Mailing Address: o v" <br />City State Zip <br />Property Site Address: 3 % yoo ZQ 167X& n k2d <br />Contact's Telephone Number: WI- fp"- d 30 e? <br />Contact's Email: 7�Cp f � s0�— z i - , �'Qr�7 <br />Legal Description of Property: lG 71 {e) ! r L ? S/ 9T5VN Xlw <br />Section Town #: �N Range #:_� W Town of: :5, <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): Le 0( t' <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: Ie (Horne/Cabin; Commercial Business; Bedroom; Deck; etc) <br />Building Contractor: SQL-- Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />�7THIS <br />-- / Nls Pe jAA1'7L /5 -Cvr `-je, 9grQ9(?• <br />-- G a ra 9� h - ,� � L4 s� -fir 1u w(4h �9�/ ,�d�,. <br />Date of staff site visit: .7 � Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: <br />UPON APPROVAL: APPLICA T 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 />a <br />m <br />CD <br />c <br />(D <br />a <br />co <br />m <br />b <br />