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C <br />l— <br />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 jWl State Statute 59.692(iv) Structures $350 <br />Filling/Grading $150 Boathouse $500 <br />Six Month Camping Unit (One Per Year) $100 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: ,.EX <br />Property Owner's Mailing Address: <br />City State Zip <br />Property Site Address: �� $(aFP (, I �r r J 1; , �Z ,�) ,�.►-j� V, <br />Contact's Telephone Number:–) I E 5:S 3 1 ,, <br />Contact's Email: <br />Legal Description of Property: C I g[ t r S K r C,,S L-,)- 1 <br />Section #: Q 5?_ Town #: 4O N Range #: W Town of:���,�JL so�J <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): 6 as y <br />Proposed Use of Structure/Addition: O IM 6f1-' D <br />Anticipated Start Date: (Home/Cabin; Commercial Busi ess; Bedroom; Deck; e1c.) <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 />5;e4,)er sYS litsAr <br />;A4,947% <br />C, ItM 1 f 1,A) �J e_ / S �- U Cla//, <br />Gerwt C4, ©dll and i�-,wlus-Ma <br />Date of staff site visit: Initials of site visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: 7 3° <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 />