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LAND USE PERMIT APPLICATION-Burnett County, 'UTE C C NEb b <br /> Applicant Complete All Sections Below This Line e. <br /> Permit Types and Fees:(Check appropriate box/boxes) a (� <br /> d <br /> Dvelling/Principal Building-Single Family $300 L.Addition to Daellinp/Principal Building-Single Family S200 <br /> Daelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family ;200 O" <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 ) <br /> Accessory Structure(Non-Bunkhouse) 5150 Bunkhouse $250 <br /> Addition to Ace.Structure 5150 jAddition to Accessory Structure-Commercial(Cl &11) $200 �. <br /> Accessory Structure-Commercial(Cl&I1) $200 Gazebo(WI Stat 59.692(lv)) $350 0 <br /> 5150 Lo <br /> Deck/Stairs/Patio/Retaining Wa1VSidewalk/Driveney& Fillingm <br /> Campground Screen Porches $125 Boathouse $500 Ag' <br /> Camping Unit(Six Months/Year) $100 ,�� <br /> Permit Extension(Valid for one year-Only 1 Allow $100 r . <br /> 0 <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,larrdrea in ,etc. <br /> L ! (1 <br /> Sc )u / <br /> Property Owner's Name: c� Z C <br /> �-7 1��f LaLsu✓oe�J t�c� <br /> Property Owner's Mailing Address: UI✓P�' a <br /> City State Zip o <br /> Property Site Address: Sb/'1')e, <br /> Contact's Telephone Number: 651 -,s-Do <br /> 0 <br /> Contact's Email: <br /> 1 .. t7 <br /> Legal Description of Property: L o, ' O� M o'-M A— A SS cssof's f l oA <br /> Section#: 3�A Town#: 39 N Range#: 116 W Town of: M eg-1-1or\ <br /> 0 <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 tarsttattemen�t): /��� "1 � y � � 1 <br /> VY <br /> Proposed Use of Structure/ ddition: /KVfYIlt_/L�eL�tn <<- V" <br /> Anticipated Start Date: /d (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) r+ <br /> C � <br /> Building Contractor: c�"�0tVt\ I nAo�jc%- Y1S i nC ,Sewer Installer: <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIQNS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 5 e-elj k ucx-� �\dk oyn1. �hG x3o sem- ter. <br /> e ho+frZ rcp 1 4's, Ia.i( Fee Rec: �Vy <br /> W441 5 dsl <br /> c c-�J <br /> N o J<Jss rc� l�An cr / M { <br /> z <br /> Date of staff site visit: 1 ( � S ��-�1 Initials of site visit staff:s � L z M <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE:U - 15 i G)O �' <br /> Pagel of 3 Z <br /> 13'urneff County, WI Land Use Application—Rev 10/2016 Z <br /> Q <br />