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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> a <br /> Applicant Complete All Sections Below This Line �' r <br /> v <br /> Permit Types and Fees:(Check appropriate box/boxes) ° <br /> v <br /> Dwelling(Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family 5200 <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings 5200 ^ <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure 5150 'p <br /> Bunkhouse 5250 Structural Alteration to Accessory Structure $150 < d <br /> Accessory Structure-Commercial(Cl &11) $200 Addition to Accessory Structure-Commercial(Cl &11) $200 .°r. <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(l v)) 5350 (� <br /> Campground Structures $125 Filling/Grading 5150 <br /> Camping Unit(Six Months Per Year) Isloo Boathouse $500 ,.o <br /> ro <br /> Permit Extension(Valid for one year-Only I Allowed) $100 3. <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 Tre9uire a different aPliaaionrorm,see corresponding aplication andrees. <br /> o' <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. n <br /> �a <br /> ""�� 1 an <br /> Property Owner's Name: .10� I-may ���/� �•� ° <br /> Lam+ <br /> Property Owner's Mailing Address: 4127 46OX O a <br /> �r t' City State Zip o <br /> Property Site Address: _1000 epi,4G7-1- <br /> Contact's <br /> {ar �AN D4 GllContact's Telephone Number. �d Y�2 `Email: p L)G S ���11 C 2 YYt If� /71p TIS r �` v o - <br /> Legal Description of Property: <br /> Section#: Town#: _N Range#: W Town of: SL ass <br /> *Attach additional page if needed far 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): <br /> Proposed Use of Structure/Addition: G <br /> Anticipated Start Date: kAfri T 1 (Home,'Cabin;Commercial Business;Bedroom;Deck;etc.) * 1 <br /> Building Contractor: � P Sewer Installer: A <br /> Z <br /> z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I <br /> Kpp 1 <br /> c_,yn�r 1� � 4' -,, vvVn c02N <br /> Fee Rec: <br /> ` I <br /> V <br /> e <br /> M <br /> N <br /> O <br /> Z <br /> n <br /> Date of staff site visit: Initials of site visit staff: <br /> PERMIT APPROVED BY ZONING OFFICIAL: <br /> Page 1 of 3 0 <br /> Burnett County, WI Land Use Application—Rev 03/2017 <br />