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LAND USE PERMIT APPLICATION — Burnett County WI r <br /> - a 1 3 <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> c <br /> b <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 m <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 O <br /> CommerciaUlndustrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 < <br /> Accessory Structure-Commercial(Cl&Il) $200 Addition to Accessory Structure-Commercial(Cl &Il) $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 y <br /> Campground Structures $125 Filling/Caading $150 <br /> m <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 `Z <br /> 'v <br /> Permit Extension(Valid for one year-Only I Allowed) $100 <br /> z <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. P <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a <br /> a Q <br /> Property Owner's Name: .,►t Ff- �C!/cN �c (i 4 <br /> Property Owner's Mailing Address: -G(90(o / L,O1� 62 <br /> G� o �itl yIj,FN (tetS,taI te Zip <br /> j-Zt{ip <br /> Property Site Address: "toon/ &410 2F/y CJ <br /> Contact's Telephone Number: o`[� <br /> Contact's Email: �PO L°"S112r'M�/I%/!�/rL <br /> d <br /> Legal Descriptio of Property: S <br /> CW <br /> f� <br /> Town#: <br /> aN tSection#: ?o � <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 1 1 <br /> J'' 1 <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Ad itio : C.1gr`are_/ A'ye ��dq <br /> Anticipated Start Date: 12 -7 n (Home/Cabm;Commerci Business;Bedroom;Deck;etc.) <br /> Building Contractor: &4rlrl4 BU I It lu.4S Sewer Installer: <br /> i m <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THISS PERMIT IS SUBJECT/TO ALL CO�N+DITIONIS,LIS/T�ED BELOW: / <br /> /1�uST /�tef S/�� : eT�evcIk Ol �v T� CyDr.� �Ym/ e{ y <br /> Irh f✓, UU ✓ Fee Rec: S a <br /> `vy u S rn �.e� {�v ad 9 r✓T b QG/� <br /> 0 <br /> z <br /> n <br /> a <br /> Date of staff site visit: Initials of site visit staff: m <br /> zz <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: <br /> �GLesSD�"y USei � PXl5�i01�/ 9'O/T l�tof:I✓Y7e- D�l.✓�1' 4/I t m _ 1 <br /> / Page 1 of 3 0 �1 <br /> Burnett County,WI Land Use Application—Rev 03/2017 <br /> x <br /> M <br /> M <br /> m <br />