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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 $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(1v) 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: C L � it <br />Property Owner's Mailing Address: ei w -T o <br />City to Zip <br />Property Site Address: laq 7 CEt-e n tU Zci <br />Contact's Telephone Number: <br />i <br />Contact's Email: C41 R— C3 g--cm-c-(K , K -116 - <br />Legal Description of Property: F W N <br />Section #:�_ Town #: N Range #: W Town of: /--N ars V) <br />*Attach 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):,:�o <br />Proposed Use of Strne4w*r Addition: <br />Anticipated Start Date: (Home/Cahin; Commercial Business; Bedroom; Deck; etc. <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 />© l -�.-s if z <br />Date of staff site visit: Initials of sit visit staff: <br />PERMIT APPROVED BY LAND SERVICES OFFICI DATE: <br />UPON APPROVAL: APPLICANT ST POST COPY OF <br />SIGNED PERMIT APPLICATION IN PLAIN SIGHT <br />Transcendent: J -L 1 a Page 1 of 4 <br />Laserfische: I L ,__ tJ Burnett County, WI Land Use Application — Rev 8/2018 <br />Fee Rec: 3 S <br />Check #: "3 <br />