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LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line 0' <br /> Permit Types and Fees; — 06J <br /> Dwelling/Principal Building-Single Family $300 Addition to D%kQlIing/Principal Building-Single Family $200 e <br /> Dv,elling/Principal Building Multi-Family $300 Addition to DKelling/Principal Building-Multi-Family 5200 0 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 t�ai` <br /> Accessory Structure(Non-Bunkhouse) $150 Bunkhouse 5250 JlJ <br /> o <br /> Addition to Acc.Structure $150 Addition to Accessory Structure-Commercial(Cl &I I) 5200 <br /> Accessory Structure-Commercial(Cl & I) $200 Gazebo(W I Stat 59.692(1 v)) $350 r- " <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Filling/Grading $150 <n <br /> Campground Screen Porches $125 Boathouse $500 <br /> Ji <br /> Camping Unit(Six Months(Year) $100 <br /> .9 <br /> ry <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 r- <br /> 0 <br /> Z <br /> "NOTE:After-the-fact(when no pennit is obtained prior to construction)is up to three times the normal fee. <br /> *Communicalion Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items nor listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> n <br /> Property Owner's Name: David G. Vejtruba and Marcia A. Vejtruba z <br /> y 7t <br /> Property Owner's Mailing Address: 12502 180th Street Kimball MN 55353 a d <br /> City State Zi ^p <br /> Property Site Address:— ;G-7 4 54,,+e Rb 71 DAnbury wr �o <br /> n <br /> Contact's Telephone Number: 320-398-2341 N W I <br /> Contact's Email: dgvej@yahoo.com t <br /> a <br /> Legal Description of Property: See attached copy of Deed <br /> 17 41 15 Swiss <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number;found on tax statement): 21386 <br /> Proposed Use of Structure/Addition: Home/Cabin <br /> G <br /> Anticipated Start Date: Spring 2017 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Owner Sewer Installer: Oc5ph�h S 54+11r(=faJeTXk z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d <br /> �a +3 f �C'a� S FeeRec.300 <br /> C <br /> M n t <br /> 2-21- !7 M m <br /> Date of staff site visit: Initials of site visit staff: S� D� ©m � LS !J <br /> Z � 1�1 <br /> PERMIT APPROVED BY ZONING OFFICIAL: " _ 7-1 <br /> DATIs a�` �� {Z ® ry <br /> 0 <br /> Page I of 3 Z t�! <br /> Burnett County, WI Land Use Application —Rev 10/2016 :� ==p <br />