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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 <br />/Alteration to Dwelling/Principal Structure $200 <br />Commercial/industrial Structure $300/Alteration to Commercial/Industrial Structure $200 <br />Accessory Structure (Garage, Shed, etc.) $150 to Accessory Structure $150 <br />Accessory Structure (Commercial/Industrial) $200/Alteration to Bunkhouse $150Deck/Stairs/Patio/Retaining Wall/Sidewalk se $250 <br />Driveways/ & Campground Structures $125 Statute 59.692(1v) Structures $350 <br />Filling/Grading $1.501 Boathouse $500 <br />Six Month Camping Unit (One Per Year) 1$1001 Permit Extension (1 Year Extension - Allowed Once) $100 <br />*NOTE: After -the -fact permits (permit aquired after construction has begun) may cost up to three times the normal fee. <br />*Communication Towers & Signs require a different application form; see corresponding application, and fees. <br />*Items not listed above will be treated as accessory structures, "�such as: pergolas, landscaping, etc. <br />Property Owner's Name: 40 y,. W �� >tio be L4 M, A( l a tl <br />Property Owner's Mailing Address: r W1 54$ <br />City State Zip <br />Property Site Address: See. -643(e— <br />Contact's Telephone Number: -7 i 5-9 (k, —%9 Uri &C-1 1 6 © 7 - <br />Contact's <br />Contact's Email: 1') d rw b6Wq t c cU ma -1 Cory, <br />Legal Description of Property: o�I- rtU�5V4 1, 2 SM 619 F� (6;6vCoT.,, <br />Section #: Town #: N Range #: W Town of: JA -G k'5C v1 9 <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): 51 2: t <br />Proposed Use of Structure/Addition: r-, re, b+ t G _S '6 vn <br />%e aves � rr-OtL nd a03 P 2 i•l, <br />Anticipated Start Date: 5 • L 1$ (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: Ify M i.riMl'lrZ Sewer Installer: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CAONDITIONS LISTED BELOW: <br />O J <br />�Date of staff site visa. Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OMCLkLI.. DATE:" l� g <br />UPON APPROVAL: APPLICANT M ST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />APPROVED Page 1 of 4 <br />Rnrnett f'nnnty WT i.and ilea Annliratinn Rev 3/2[I1R <br />Fee Rec:3 S O <br />X923-) <br />M <br />n <br />W <br />H <br />a <br />0 <br />z <br />cin <br />tz <br />0 <br />