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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 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 />IAIEPStairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br />ays/ & ampt ground 5 r _ $125 WI State Statute 59.692(1v) Structures $350 <br />Filling/Grading $150 Boathouse $500 <br />Six Month Camping Unit (One Per Year) $100 Permit 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: pergolas, landscaping, etc. <br />Property Owner's Name: �J 11� �� ��) �� l �.' () '.i�r%I(��•S <br />Property Owner's Mailing Address: h2 �� J L3i : <br />� • City _ State Zip <br />Property Site Address: � V �l -f' � (j �� } pin i A ) L ,- t4 x % a <br />Contact's Telephone Number: - Sac; (_0 <br />Contact's Email: A\AA y " Gfn <br />Legal Description of Property: ;�f�)( U ) km 3L) ( l n S `vim s t- <br />Section #: Town #: N Range #: W Town of: (y 0 <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): I SLAO 1 <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: (Home/Cabin; Commercial Business; Bedrooni; Decic; 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 />_ 1.4 u 5 /- M eek a // Klrw f -At ck-%; . <br />2 x 3 Z �s C ci tM P/q r^0"11 (/- O (T7 Ce, <br />�Z- <br />Date of staff site visit: 31 Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: 10/5/0 <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 />T <br />ITI <br />0 <br />0 <br />a <br />v <br />w <br />r <br />b <br />i.+ <br />00 <br />h <br />3 <br />0 <br />5' <br />io <br />0 <br />0 <br />�� <br />