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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 <br />Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure $300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) $150 <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) $200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Bunkhouse <br />$250 <br />Driveways/ & Campground Structures $125 <br />IWI State Statute 59.692(ly) Structures <br />1$350, <br />Filling/Grading $150 <br />lBoathouse <br />$500 <br />Six Month Camping Unit (One Per Year) $100 <br />jPermit Extension (1 Year Extension - Allowed Once) <br />I $100 <br />*NOTE: After -the -fact permits (permit aqui red 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, <br />such as: landscaping, etc. <br />Property Owner's Name: r CA�1� Sl <br />@p_ergolas, <br />1 �' -G' 4f <br />►" ` <br />1 <br />�? <br />Property Owner's Mailing Address: <br />1 <br />I <br />_ Cjityj State Zi <br />( / <br />'7"f <br />ym <br />Property Site Address <br />(i l�'L (A <br />Contact's Telephone Number: % (z K 5 <br />—6!�,S� $-0z�- <br />Contact's Email: <br />`- <br />S ouevK W t ST <br />SO uAIn(i Y <br />Legal Description of Property: <br />Section #: —Town #:b N Range #:�W Town of: <br />*Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tIlYstem property page. <br />3(-Q <br />Tax ID # (1-5 digit number; found on tax statement): <br />--�3 <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: <br />(Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: �)is�u'1�'ti <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 />APPROV[D <br />Date of staff site visit: <br />Initials of i e visi taff: <br />TTT1�.TiT ♦ TTT ATITT Tom) T ♦ 1�TT C�TTTIT l�T CT ATTT!'i <br />1 T _ <br />I 111%1V111 t11 1 1%V V lilt 111 Ltll\L UL' 1IL V 1VL` l7 Vl`1'll.l - LE'11 L` <br />UPON APPROVAL: APPLICANT M 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 />v <br />pa <br />0 <br />0 <br />0 <br />0 <br />%■ <br />n <br />C <br />0 <br />ro <br />oa <br />r <br />b <br />Fee Rec)SO <br />* 1738 <br />=; <br />�M.Fmul <br />