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0 <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 $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 Addition/Alteration 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: DA�vf_ �'zy�/� rLf� i.Ac�rq- �nnL� -j i -z p¢4 -/G_ <br />Property Owner's Mailing Address: fl . e a. (L% + S uz— S -q661 <br />¢ City State Zip <br />Property Site Address: ,I7 a FS T:j� leydf, LA% ?'L �e5 � S'Zji 73 <br />Contact's Telephone Number: .61-09 %SD- 0ZI �SeeTT TiCc, !ice ,s�• 7E- o33� <br />Contact's Email: O(Ade.. 49 &i _Zo4yli 0164-1.2 <br />Legal Description of Property: eol�ef'S 5��, of LIZ S . ?`f ! yid IU 1? w I�els ��� ��r� <br />I <br />Section #: 3 4 Town D N Range #:�(o W Town of: <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): 14 1 71 <br />Proposed Use of Structure/A dition: (�"(,ti �14a _<. _ <br />Anticipated Start Date:_ I S (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor:Tj C `�S E,ry o.� Sewer Installer: $44 +. Sri I cA- exec,., <br />!z>Cc,f4 -/13-T(6-O`73 S— <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />F"J � / J S � \1 b c <br />Date of staff site visit: S I Initials of site 'sit staff. <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: 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 />a <br />C <br />0 <br />0 <br />r <br />0 <br />11, <br />1" <br />ro <br />rD <br />z <br />0 <br />1, <br />LIC <br />X <br />d <br />S <br />0 <br />z <br />Q <br />5 <br />