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LAND USE PERNIIT APPLICATION—Burnett County, WI a <br /> Applicant Complete All Sections Below This Line ~ <br /> a � <br /> Permit Types and Fees:(Check appropriate box/boxes) C <br /> Dwelling/Principal Building-Single Family $30011 jAdditin to Dwelling/Principal Building-Single Family $200 <br /> Dmiling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings 5200 <br /> CommerciaUlnd atrial Building $300 Addition to Commercial/Industrial Building $200 1 a <br /> Accessory Struclure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> -� n <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 _ <_- <br /> Accessory Structure-Commercial(Cl &11) $200 Addition to Accessory Structure-Commercial(Cl &11) $200 <br /> XDeck/Sta' Patio taining Wall/Sidewalk/Driveway& C*=bo(WI Stat 59.692(lv)) $350 <br /> Campground Structures $125 1 Fillinp/Gradng $150 <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 <br /> ro <br /> a <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 S <br /> z <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. <br /> *Communication Towers&SiSte'require a dt8rent applicationform,see corresponding application and/&r. <br /> o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> L <br /> Property Owner's Name: RI—C)"- --cl5 1't t <br /> Property Owner's Mailing Address: 31 C} —q --%A- <br /> r�l�� City State Zip o <br /> Property Site Address: 72.b,-1W �(,Qly- aot� -, p�S�Z^� <br /> Contact's Telephone Number: SD � Z <br /> I*- � skx—�Oc I 1 ° I <br /> 5' <br /> Contact's Email: .KSI(\1�T L�SQ � ST• tT 1 <br /> m <br /> Legal Description of Property: Q C1 * L*3 I <br /> Section#: Z9 Town#: 3- 1 N Range#: W Town of: ` r'Pr&LakL <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): -ZLALA ot� -1 ` <br /> Proposed Use of Structure/Addi 'on: �'�'(n <br /> Anticipated Start Date: U M A (79ome/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: `� Sewer Installer: m <br /> z <br /> w <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Fee Rec:� ri181 <br /> 4V �e v�-tN►o U e� � <br /> Vl <br /> t7 <br /> b y <br /> 1613112-c217 N <br /> � a <br /> Date of staff site visit: Initials of site visit staff: C �� <br /> 0 N Z <br /> PERMIT APPROVED BY ZONING OFFICIAL: ATE: 7 3/ z Z 0 --, <br /> Page 1 of 3 v Z <br /> Burnett County,WI Land Use Application—Rev 03/2017 <br /> x <br /> m <br /> �ii <br />