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LAND USE PERMIT APPLICATION — Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />W'Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure <br />$300 <br />Addition/Alteration to Dwelling/Principal Structure <br />Commercial/Industrial Structure <br />$300 <br />Addition/Alteration to Commercial/Industrial Structure <br />Accessory Structure (Garage, Shed, etc) <br />$150 <br />Addition/Alteration to Accessory Structure <br />Accessory Structure (Commercial/Industrial) <br />$200 <br />Addition/Alteration to Bunkhouse <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Driveways/ & Campground Structures <br />$125 <br />Bunkhouse <br />WI State Statute 59.692(ly) Structures <br />Filling/Grading <br />$150 1 <br />Boathouse <br />Six Month Camoins Unit (One Per Y(ar) <br />$100 I <br />Permit Extension R Year Extension - Allowed Once) <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 londscapinq, etc. <br />Property Owner's Name: <br />Property Owner's Mailing <br />/y M/�C, Lc - <br />Property Site Address: -Qy/St5 xlrl/% <br />Contact's Telephone Number: %/ 5-- �6% -1 JOS, <br />hz,e k S' <br />City ' State <br />Contact's Email �py,, - (1G t%�'��`�C� <br />Legal Description of Property <br />Section #: Town #: <br />0 <br />J� <br />$200 <br />$15011 � <br />$150 A <br />$250 <br />$350 <br />$500 i <br />$100 cd <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): 1 // 50 <br />Proposed Use of Structure�Addition: At, oty1g`� /��hr�� �-��< �S>•��� �t/�%/y f�©�lG'• <br />Anticipated Start Date:", f (Home/Cabin; Commercial Businevs; Bedroom; Deck, etc.) <br />Building Contractor: 40"ML%ai`����,/���'�i^ �C.;�:>>i�r� LsP� Sewer Installer: PEa <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 site visit staff: <br />-13 yg <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: 6Lk _DATE: <br />UPON APPROVAL: APPLICANT MUST 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 />M <br />0 <br />0 <br />b <br />d <br />0 <br />o� <br />bCD <br />r <br />b <br />y N <br />w <br />C <br />a. <br />P py <br />w <br />C O <br />F <br />_ 0 <br />h <br />4, V _ <br />O <br />o <br />00 (` <br />N <br />� 1 <br />a <br />00 <br />d 0 <br />x <br />-3 � d <br />z 5 I <br />mod^ <br />Fee Rec: <br />0,4,46 q 308' <br />L <br />c" <br />i�U <br />