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fp <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a b <br /> N � � <br /> Applicant Complete All Sections Below This Line v <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 1 <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 I <br /> 1 <br /> Commercial/Industrial Building $300 Addition to CommerciaVlndustrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 M <br /> G1 <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 < <br /> Accessory Structure-Commercial(Cl &11) $200 Addition to Accessory Structure-Commercial(Cl &11) $200 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(]vp $350 <br /> Campground Structures $125 Filling/Grading $150 <br /> d <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 <br /> 'v <br /> m <br /> Permit Extension(Valid for one year-Only I Allowed) $100 <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&Signs require a different a licadon orm,see corresponding application and ees. <br /> 8 9PP f P 8 PP f o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 9 <br /> Property Owner's Name: cxx'm_ A. C7 I dcorR t V\1 <br /> Property Owner's Mailing Address: G 19 Lmkkreo.e ki c c t <br /> City State Zip o <br /> Property Site Address: (236LA Mt L14.3� S 1f evi t WZ Sal 7 aj <br /> 1 <br /> Contact's Telephone Number: (; '51 - 334—1301 � v� <br /> 2. <br /> Contact'sEmail:���\nr� \� hn�wLc��\ GCSVY� d <br /> p� 1 1 y <br /> Legal Description of Property: Sae- i�11 A » <br /> Section#: Town#: 39 N Range#: W Town of: 1. 1 <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): <br /> 4�llas � I <br /> Proposed Use of Structure/Addition: I I.5 X�`6 S hr,�- t��acv��.e_u\ a� �a x a`d 5 <br /> Anticipated Start Date: NS A9 (Home/Cabin;Commercial Business;Bedroom:Deck;etc.) <br /> Building Contractor: (V/ Sewer Installer: IL�i� y z <br /> w <br /> `A <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> F <br /> Fee Rec: �SO <br /> a <br /> z <br /> y <br /> h <br /> z C <br /> L ^ <br /> ti Z C 1Qlr'lut"tY, <br /> Date of staff site visit: 1 Initials of site visit staff: �No m z <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: Zia O ^� <br /> 0 <br /> Z ll�vll <br /> Page 1 of 3 0 <br /> Burnett County, WI Land Use Application—Rev 03/2017 > �� <br /> m <br /> m <br />