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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 <br />$200 <br />Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) $150 Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) $200 Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse <br />$250 <br />Driveways/ & Campground Structures $125 WI State Statute 59.692(1v) Structures <br />$350 <br />Filling/Grading $150 Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) $100 Permit Extension (1 Year Extension -Allowed Once) <br />$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: -S ,�' / t% F / 1Allah h k -5 <br />Property Owner's Mailing Address: 7 �� L• O /� f�� �1�£� j+/ <br />City State Zip <br />Property Site Address: a 8 6 (7 Ct-e sc-cn+ L o K e, Ln , w ebsJ-cc w= <br />/ <br />Contact's Telephone Number: <br />Contact's Email: r - <br />Legal Description of Property:4 OCs 0) U "1 . t) <br />i 61 Paaa <br />Section #: Town #:`"'/�'O N Range #:W Town of: S Co -* <br />*Attach additional page if needed for 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): 19161 <br />Proposed Use of Structure/A A ditio 6 kn Q <br />Anticipated Start Date:- -S (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: -'r a) Sewer Installer: eobA% tc h <br />'86 <br />♦ TT ♦ TTi -7 T7TT[l i <br />Aiyr-A DL' LVyy i nlS LUNE run LA1yL 31LA V 11L hJ b l Ar l' COryfi V1r;NTSiCONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />I <br />Date of staff site visit: il- CA — ( T Initials of' e visit st f: <br />-L. - <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 />IT7 <br />I <br />00 <br />MY <br />• <br />RN <br />O <br />I~ ' <br />G' <br />d� <br />x <br />d <br />CA <br />Fes. <br />d <br />y Fee Rec330 <br />x <br />