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LAND USE PERMIT APPLICATION — Burnett County WI <br />r <br />a <br />Applicant Complete All Sections Below This Line' <br />Permit Types and Fees: (Please, check appropriate boxes) <br />m <br />_CD <br />O <br />Dwelling/Principal Structure $300 1 X lAddition/Alteration to Dwelling/Principal Structure <br />Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure <br />Accesso Structure (Garage, Shed, etc. <br />rY ( g ) $150 Addition/Alteration to Accessory Structure <br />Accessory Structure (Commercial/Industrial) $200 Addition/Alteration to Bunkhouse <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(1v) Structures ]$350 <br />C <br />W � � <br />� <br />Filling/Grading $150 Boathouse <br />Six Month Camping Unit (One Per Year) $100 Permit *tension (1 Year Extension - Allowed Once) <br />*NOTE: After-the-factermits <br />p (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 />0 b <br />*Items not listed above will be treated as accessory structures, such as: pergolas, landscaping, etc. <br />5 <br />Property Owner's Name: <br />AiVf � % on gSr 11) <br />z <br />Property Owner's Mailing Address: <br />Property Site Address: l�`d�i3 A). <br />CWT a NE 9Em10J <br />AVOG 1 J -0-h6 ve. city <br />MV 5660 ii <br />State Zip <br />Contact's Telephone Number: 1 g' ! y <br />Ll —9Y37 <br />Contact's Email:—j 7 Anmpsp to PPqz-eu Ny)✓. rir- <br />Legal Description of Property: S&t /4-TTrI}Cfj,�5O <br />Section #: 3y_ Town #: _q J_N Range #:jj� _W Town of:SW/ 2S <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br />Tax 1D # (1-5 digit number; found on tax statement): �;L 4D.-.0 6 <br />Proposed Use of Structure/Addition: C 14Q1N- AN 0 E0"ro- FMLAA4- L r V, R)". <br />Anticipated Start Date: d caNC 20ff (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor:5%piJ1EgoeS Off/:/ Sewer Installer: IVA <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: Is Initials of sit visit staff <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: 44�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 />N <br />5. <br />ao <br />d <br />0 <br />x <br />e <br />r� <br />r <br />::� I��yycc I <br />Fee Rec:7� 06 <br />a0-< <br />A <br />C= <br />N <br />O <br />co <br />