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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 <br />Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure $300 <br />Addition/Alteration to Commercial/Industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) $150 <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) $200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Driveways/ & Campground Structures $125 <br />Bunkhouse <br />WI State Statute 59.692(ly) Structures <br />$250 <br />$350 <br />Filling/Grading $150 <br />Boathouse <br />$500 <br />Six Month Camping Unit (One Per Year) $100 1 <br />jPernnit 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: Q c! e- 9 4- t hc�cc (Vt, <br />Property Owner's Mailing Address: 7d <br />t'-Le,rtet— A,t.11 J 't b <br />1 LO , City State Zip <br />Property Site Address: ��`� bo vn%el uhyts�.� Dict g:�e� <br />Contact's Telephone Number: h PYX, 7/S- l 7 O- F U. l <br />Contact's Email: 1' i� i+' I Q S JDj ; I p� L.+�S G6 S -6--r w <br />Legal Description of Property: <br />Section #: ( Z Town #: .�S N Range #: 1 W Town of: L�cwH,t�r <br />*A ttach additional page if needed for lengthy 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): �Jys <br />Proposed Use of Structure(Addition: ��eo+. <br />Anticipated Start Date: it( e {� -) 4)ik (Home/Cabin; Commercial Business,- Bedroom; Deck; etc.) <br />Building Contractor: P tL� TJ wtv, De 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 />1- <br /><94 <br />�VST <br />6 <br />Date of staff site visit: ` Initials of s' a visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICI DAT t <br />UPON APPROVAL: APPLICANT MU 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 />%n <br />O <br />0 <br />C <br />a <br />N <br />0 <br />On, <br />0 <br />2 <br />r <br />b <br />F� <br />x <br />0 <br />O <br />S <br />LA <br />Fee Rec:3° `� o <br />< <br />l <br />zw <br />r(rVV41 <br />z o <br />i <br />� C <br />co <br />0 <br />