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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 <br />$200 <br />Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) $150 Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) $200 Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse <br />$250 <br />Driveways/ & Campground Structures $125 jWl State Statute 59.692(1v) Structures <br />$350 <br />Filling/Grading $150 lBoathouse <br />$500 <br />Six Month Camping Unit (One Per Year) $100 1 Permit Extension (1 Year Extension - Allowed Once) <br />$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: A✓k, int t �1h( <br />17115-551—"Avt ty L, `53y r <br />Property Owner's Mailing Address: t/V • <br />City State Zip <br />Property Site Address: 19 110 -<a--y6 C Q nl¢r . W - <br />Contact's Telephone Number: 72 fo3 .S� & . D 6Q l <br />Contact's Email: hi AAe�• S 4.C- 6t k4', . AA <br />Y �o <br />Lj <br />Legal Description of Property: Ill O - oa3 as a.4ar, <br />Section #:1b Town #: q 0 N Range #:-11—W Town of: SGS <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): 177S 772 7 j <br />Proposed Use of Structure/Ad 'tion:e— to, <br />Anticipated Start Date: (Home/Ca in; Commerci 1 Business; Bedroom; Deck; etc.) <br />r✓ <br />Building Contractor: Oh 5— Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISLTED BELOW: <br />W, cvn <br />aCC�-k�� <br />Date of staff site visit: S --is- n7 Initials of <br />PERMIT APPROVED BY LAND SERVICES <br />UPON APPROVI <br />visit staff: J� <br />DATE: <br />T 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 />r <br />7 <br />s� <br />a C7 c�- <br />O <br />CD <br />-, <br />p <br />0 <br />o � � <br />Ln <br />b <br />� z <br />0 <br />0 <br />^a <br />m n <br />t Ln <br />o y �� <br />o <br />o ua <br />o <br />00 <br />C7 <br />n <br />o � <br />O � <br />C7 <br />I ti <br />0 <br />z y <br />y Fee ReA T5-, <br />esti �� <br />