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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 $3 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 <br />Add 'I <br />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 WI State Statute 59.692(ly) 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: 0,j -j- 'r M e!r=anJ eAisca, ✓ <br />Property Owner's Mailing Address: Owe de y1f ti/ r lt%S _y 8" <br />/ � 1 City State Zip <br />Property Site Address: l / % <br />Contact's Telephone Number:7; J S % 3; C;1 27 <br />Contact's Email: M ttp- ,/rf'x,- I/�_i �/r✓�}/r�Qr,'� r� <br />Legal Description <br />r <br />of Property: �-S 1A 7/ e!!� <br />Section #: "3& Town _N Range #: /7 W Town of: L/be"t` E,)!✓ <br />*Attach additional page if needed fortelengthy description OR attach a copy of the deed OR attach tar system property page. <br />Tax ID # (1-5 digit number; found on tax statement): <br />Proposed Use of Structure/Addition: lyM e - <br />Anticipated Start Date: 314/ `�l Hom Cabin; Commercial Business; BedroomTDeck/; etc.) / <br />Building Contractor: ( AVe Installer: % 0 �;5 <br />AREA BELONN' 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. J S Initials of sit vi its f <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE:% -/D -/S' <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 />CIO <br />a <br />0 <br />CIO- <br />Fee Rec: 3 © a <br />0 <br />