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LAND USE PERMIT APPLICATION — Burnett Countv, W1 <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Please, check appropriate boxes) <br />Dwelling/Principal Structure <br />$300 <br />Addition/Alteration to Dwelling/Principal Structure <br />$200 <br />Commercial/Industrial Structure <br />$300 <br />Addition/Alteration to Commercial/industrial Structure <br />$200 <br />Accessory Structure (Garage, Shed, etc.) <br />$150 <br />Addition/Alteration to Accessory Structure <br />$150 <br />Accessory Structure (Commercial/Industrial) <br />$200 <br />Addition/Alteration to Bunkhouse <br />$150 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk <br />Bunkhouse <br />$250 <br />Driveways/ & Campground Structures <br />$125 <br />JWI State Statute 59.692(ly) Structures <br />$350 <br />Filling/Grading <br />$150 <br />lBoathouse <br />$500 <br />Six Month Camping Unit (One Per Year) <br />$100 <br />1 <br />jPermit 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 notfisted above will be treated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: �{�//i�.�G 014 AIC —'Ta e-&"Sa.t <br />Property Owner's Mailing Address: Doi CE'�-�''� 4t/e S 7 <br />City State Zip <br />Property Site Address: flob L j4f< (-Cu j QATN <br />Contact's Telephone Number: 41 Z.— 74 9=10Qlp <br />Contact's Email: % • 5'le'So.t� �q�t S} ��,• <br />Of�m __ <br />(C <br />Legal Description of Property: l6"- `s <br />Section #: Town #:'�,SN Range 4:` w Town of: <br />*Attach additional page if needed for lengthy description OR attach a copv of the deed O7� h tax system property page. <br />Tax ID # (1-5 digit number; found on tax statement): <br />Proposed Ulse of Structure/Addition: �S�o,2.t�G /"16Gv_ a 115 <br />Anticipated Start Date:--� `s--A (ilome,Cabin: Commercial Business: Bedroom: Deck; etc.) <br />Building Contractor: REr'/K/C2 �'T�ASIt't>ILgtNGS Sewer Installer: <br />AREA BELONN "1'HIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />- Shed not 710 6e usCa/ -6'0 A to i,4K 1 It /o/�' <br />Initials <br />Date of staff site visit; of site visit 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 />r <br />o <br />i <br />� <br />C <br />f0 <br />zn <br />� <br />f6 <br />o <br />y <br />y j <br />y <br />o <br />m <br />w <br />a <br />:r <br />� <br />a <br />vv <br />z <br />6� <br />t� <br />o0 <br />Fee Rec: 1l50► <br />t <br />C <br />Z <br />0 <br />co <br />