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rM <br /> LAND USE PERMIT APPLICATION—Burnett County, W1 <br /> a <br /> MOO* O <br /> Permit Types and Fees:(Check appropriate hoxlboxes) <br /> su <br /> Dwelling/Principal Building-Single Family $300 lAddition to Dwelling/Principal Building-Single Family $200 <br /> iDwelling/Principal Building-Multi-Family $300 Structural Alteration to D�elling/Principal Buildings $200 <br /> I Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> 'Accessory Strut urc(Non-Bunkhouse) $150 jAddition to Accessory Structure $150 <br /> M <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $15 <br /> lAccessory Structure-Commercial(Cl &11) $200 lAddition to Accessory Structure-Commercial(CI &I 1) $200 <br /> ,Dcck/Stuirs/Putio/RetainingWall/S � � <br /> delk/Drivey& Gazebo(WI Stat 59.692(lv)) $350 rCampground Structures $125 X Filling/Grading $ISO <br /> Camping Unit(Six Months Per Year) $100 Boathouse $50f <br /> 0 <br /> lPermit Extension(Valid for one year-Only I Allowed)_$100 <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 applicationform,see corresponding application andfces. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: oet C,rN <br /> V4 AAA'�, <br /> .19 <br /> Property Owner's Mailing Address: V32-d e-1c2ult 94 <br /> U <br /> Stare Zip <br /> Property Site Address: Z—,o <br /> Contact's Telephone Number: lb -3(eiO N <br /> 0 N <br /> Contact's Email: j G2,a5-e, - ,o I VA <br /> Legal Description of Property:Ld A -_j I-e-5 <br /> Section#: Town#: N Range W Town of: /4A j <br /> Lh*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): 2— 1 <br /> Proposed Use of Structure/Addition: r—A Lke— /jGt <br /> Anticipated Start Date', Lj (Ham /Cabin:Commercial Business;Bedroom:Deck, etc.) <br /> Building Contractor: Sewer Installer: <br /> P�14�ijj I A/-A AtZ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> cin-s4 Fee Rec: Is o <br /> Date of staff site visit: Initials of site visit staff. <br /> :V C_ <br /> N <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE:- 0 <br /> 4", <br /> Z00 <br /> Pagel ol`3 C: <br /> Burnett County, WI Land Use Application—Rev 03/2017 <br />