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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 I Bunkhouse $250 <br />Driveways/ & Campground Structures $125 IWI State Statute 59.692(1v) Structures $350 <br />Filling/Grading $150 1 lBoathouse $500 <br />Six Month Camping Unit (One Per Year) $100 1 jPermit 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: 6L U# -6 : AAaW - t <br />Property Owner's Mailing Address: tai , La- � Road d 1 549-3c <br />City State Zip <br />Property Site Address: SQ,yy) <br />Contact's Telephone Number:��d�� 2� - <br />Contact's Email: sGm a kt e- P a ma <br />Legal Description of Property: D -1 V • le -4 Pj A Q57 <br />Section #: T Town #: LW N Range #: 115 W Town of: Ja ctc .& A, <br />*Attach additionalpage if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br />Tax ID # (1-5 digit number; found on tax statement): 50-56 , <br />S <br />Proposed Use of Structure/Addition: Deck > S k <br />Anticipated Start Date: S l.(,Pbt er (H me/Cabin; Commercial 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 />02, <br />Date of staff site visit: Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIA J'✓ DATE: <br />UPON APPROVAL: APPLICANT 4ST 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 />