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LAND USE PERMIT APPLICATION— Burnett County, WIcl <br /> a <br /> Applicant Complete All Sections Below This Line 0' ►+ <br /> Permit Types and Fees:(Check appropriate hox/boxes) <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 v }}-p�— <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 E <br /> CommerciaVlndustrial Building $300 Addition to Commercial/Industrial Building $200 C n <br /> Accessory Structure(Non-Bunkhouse) $150 Bunkhouse $250 ^� <br /> 0 1 p <br /> Addition to Acc.Structure $150 Addition to Accessory Structure-Commercial(CI &11) $200 <br /> Accessory Structure-Commercial(Cl &11) $200 Gazebo(WI Stat 59.692(lv)) $350 <br /> Deck/Stairs(Patio/Retaining WaWSidewalk/Driveway& Filling/Grading $150 DL) w <br /> Campground Screen Porches $125 Boathouse $500 4- <br /> Camping Unit(Six Months(Year) $100ou .y <br /> Permit Extension(Valid for one year-Only I 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. g I U <br /> *Communication Tower.;&Signs require a different application fo m,see corresponding upplication and fees. , <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a <br /> Property Owner's Name: b) ��r1 N J SD e7 ro- U CL►r1C P k �[3Y1 c Ul <br /> o � <br /> Property Owner's Mailing Address:--219 4 W c 4JE fi'V93 $ <br /> 1 City State Zip o <br /> Property Site Address: 611151��t i� (-igk-e, ZA W ri e/JF/ ✓ie 1.Ur <br /> Contact's Telephone Number:. ":5 o y 3 o, ee o� <br /> Contact's Email: Pt)&C 1 j 6Yl �i l C-4,n 1 d <br /> a <br /> Legal Description of Property: <br /> Section#: j Town#:_ N Range#:__I_L _W Town of:�r4c2q. kG y (S <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page.* C <br /> Tax ID#(1-5 digit number;found on tax statement): aa ^� 1 <br /> Proposed Use of Structure/Addition: �}T jCr,�eaja)n <br /> Anticipated Start Date: A!5t4 (Horne/Cabin;Commercial Business;Bedroom;Deck:etc.) I <br /> Building Contractor: Sewer Installer: z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> 9rLr7Q DUD"IT rc CITRJVC'T Tn AI.I, cnNDITIONS LISTED BELOW: r. � <br /> CA M T5 <br /> Fee Rec: <br /> y <br /> N <br /> ya� <br /> Z W <br /> ^ � X M <br /> Date of staff site visit: I Q ' I Initials of site visit staff: �3 l� N m 0 <br /> �7 2 Z rn c <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE —J _I / <br /> 20 o <br /> 7 C: cm <br /> Z v <br /> Page 1 of 3 0 <br /> Burnett County, WI Land Use Application—Rev 02/2017 <br /> M <br /> a <br /> m <br />