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LAND USE PERMIT APPLICATION— Burnett County, WI <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> a � <br /> d <br /> DwellinPrinci al Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> g <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) $150 Bunkhouse $250 [�n <br /> Addition to Ace.Structure $150 Addition to Accessory Structure-Commercial(Cl &I1) $200 a 1 <br /> Accessory Structure-Commercial(Cl &11) $200 Gazebo(WI Stat 59.692(l v)) $350 0 _� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Filling/Caading $150 r <br /> Campground Screen Porches $125 Boathouse $500 <br /> iv <br /> Camping Unit(Six Months/Year) $100 b <br /> m <br /> Permit Extension(Valid for one year-Only l Allowed) $I00 r- <br /> o - <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 application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. <br /> n � <br /> Property Owner's Name: <br /> Property Owner's Mailing Address: d o CJ <br /> (� <br /> L City State Zip <br /> —t G <br /> Property Site Address: 1 a-1 s L U_ill Ra(�T�nmlk Luc4 W= <br /> Contact's Telephone Number: Qj(D -l r� co N uo <br /> Contact's Email: GO,ef? Qp_ @ C-0 Com <br /> d <br /> Legal Description of Property: <br /> I <br /> Section#: Q:S_Town#: L )N N Range#:_A_�a�W Town of. <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ) b <br /> Tax ID#(1-5 digit number;found on tax statement): I _3 j195 J" -1 <br /> Proposed Use of Structure/Addition: Ug!) rn t1_ 'AT)A watt= <br /> Anticipated Start Date: 01 - a.0I ce (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) O <br /> Building Contractor: Sewer Installer: n z O <br /> y <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY 8 V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> • f rs�a..l� .5`���' �c�c.c_ o-s t <br /> • 5 c� S vJS �j cmv+ dJ v% Fee Rec: L <br /> -d� a- .rte 16(7n_ 'p ° ree) <br /> S rarer o L <br /> c -�J <br /> Date of staff site visit: Initi is of site visit staff: -STZ CD <br /> C <br /> �J I <br /> PERMAPPROVED BY ZONING OFFICIAL: DATE: D �I O N <br /> Page 1 of 3 Z iT <br /> Burnett County,WI Land Use Application—Rev 10/2016 4 = <br />