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LAND USE PERMIT APPLICATION— Burnett County, WI g <br /> Permit Types and Fees:(Check appropriate box boxes) <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> DmIling/Principal Building-Multi-Family $300 Addition to Dmelling/Principal Building-Multi-Family $200 n <br /> CommerciaVlndustrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) $150 Bunkhouse $250 <br /> Addition to Ace. Structure $150 Addition to Accessory Structure-Commercial(Cl &Il) $200 a- <br /> .Accessory Structure-Commercial(Cl&Il) $200 Gazebo(WI Stat 59.692(lv)) $350 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Filling/Grading $150 . <br /> Campground Screen Porches $125 Boathouse $500 Q}� <br /> Camping Unit(Six Months(Year) $100 / <br /> ro <br /> Permit Extension(Valid for one year-Only 1 Allosxed) $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&Signs require a different application form,see corresponding application and fees. Q �� <br /> *Items not listed above will be treated as accessary structures,such as:pergolas,landscaping; etc. ty <br /> 5 � y <br /> Property Owner's Name: ._f Wlolieh ! Wl�trre�. WloStiet- o <br /> Property Owner's Mailing Address: 3 SSl 14 o U ZAC4 i'Y1 r,, SSI K - 9`10.3 _ a <br /> Property Site Address: (0 3(j [-.�(-�4 �Qh City State Zip e. � g <br /> Contact's Telephone Number: 9 S Z - $ 3(. - <br /> Contact's Email: dQh e_(Z W4Nre t3 vt �A tv rri y <br /> 5. <br /> Legal Description of Property: <br /> Section#: Town#: N Range#: W Town of W y <br /> o <br /> *Attach additional page ifneeded for lengthy description OR attach a copy of the deed OR attach tax system property page.* 1 <br /> Tax ID#(1-5 digit number;found on tax statement): I� pp <br /> Proposed Use of Structure/Addition: 34 X3 z eb&6,a �-td 6- Tit�T � <br /> Anticipated Start Date:Mal doll (Home/Cabin;Commercial Business;Bedroom;Deck;eta.) <br /> r Q r ' r <br /> Building Contractor: e-�S (-k. UO-In r_ Sewer Installer: z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDmONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Ap�rov2�1 ��r she Vt's;V, ///oJ� %o & �selr Hvna,r. H�d, ��. <br /> ` * Fee Rec:l S d <br /> o <br /> z <br /> 4 <br /> n <br /> (� y _z. <br /> Date of staff site visit: .�-a,- �� 1 ' ' Is of site visit staff: <br /> a GU <br /> ►.. <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: 17-.1 - 1-1 N <br /> � o <br /> Page 1 of 3 ,- - <br /> Burnett County,WI Land Use Application-Rev 02/2017 <br />