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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 Addition/Alteration to Dwelling/Principal Structure $200 <br />Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) $150 Addition/Alteration to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br />Driveways/ & Campground Structures $125 jWl State Statute 59.692(1v) Structures $350 <br />Filling/Grading $150 Boathouse $500 <br />Six Month Camping Unit (One Per Year) 1$100 1 113ermit Extension (1 Year Extension - Allowed Once) $100 <br />*NOTE: After -the -fact permits (permit aquired after construction has begun) may cost up to three times the normal fee. <br />*Communication Towers & Signs require a different application form; see corresponding application, and fees. <br />*Items not listed above will be treated as accessory structures,, such as: pergo <br />/laoss,landscaping, etc. <br />tr <br />Property Owner's Name: /1 chn kzA ,yAa tzi 11-16 1 Z <br />Property Owner's Mailing Address: TO l� Nita 62& 0 l�i�% <br />��� -�- `, ,( /� City State Zip <br />Property Site Address: _3nwo 70k/- LOA (j�' /Q(41 i / for 5"y$`3y <br />Contact's Telephone Number: 307,/0 — / fSo' S��3 <br />Contact's Email: d Klein Zp- <br />Legal Description of Property: 57ee- Q' C <br />Section #: Town #:�N Range #: W Town of: Sw/ <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): ,3-2 60,2, <br />Proposed Use of Structure/Addition: K (ate 5zaina�Q—P <br />Anticipated Start Date: (HomelCabin; Commert+ial Business; Bedroom; Deck; etc.) <br />Building Contractor: 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 />-1� <br />Date of staff site visit:_ — Initials ofvisit staff: <br />9 4 L�9 <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: <br />UPON APPROVAL: APPLICANT MU 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 />N <br />c. <br />v \ <br />C7 <br />o <br />z <br />z <br />lS� <br />0 <br />Fee Rec: <br />