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LAND USE PERMIT APPLICATION -Burnett County, WI Cl) r <br /> .- b <br /> Applicant Complete All Sections Below This Line a. CD <br /> ' <br /> Permit Types and Fees:(Check appropriate box/boxes) : <br /> d <br /> lDwelling/Prw <br /> Dwelling/Principal Building-Single Family $300 <br /> Addition to Dwelling/Principal Building-Single Family $200 , 4: <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 ^'� o <br /> 'Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 (J\ g <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 ,.' "17c:\J <br /> o <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 <br /> 'Accessory Structure-Commercial(Cl &II) $200 Addition to Accessory Structure-Commercial(Cl &II) $200 0 „� ` <br /> Gazebo(WI Stat 59.692(1v)) $350 cn "— <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& m <br /> X 'Campground Structures $125 Filling/Grading $150 <br /> w <br /> to <br /> 'Camping Unit(Six Months Per Year) $100 Boathouse $500 . <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 I o <br /> t <br /> vs <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. <br /> Z, <br /> ir <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. Il <br /> o N....) r <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. b a <br /> p tt e- 44,4 .5 CeoK{ " `� <br /> Property Owner's Name: 2- =f' � -o <br /> E 4t <br /> Property Owner's Mailing Address: P( 6OX 3 t�Cciibury �I - 5(f3O AS •• a <br /> �y / t City/ State Zip -e <br /> Property Site Address: 0 a�� S P fel DGc n bu(t,, %,tli J`4ac C) Po <br /> Contact's Telephone Number: g)aZ- T(Y1 0).44 Nas <br /> sq <br /> Contact's Email: cC.A."0k t'( c it vte. &Ian 0 <br /> Legal Description of Property: ) ` <br /> Section#: p�Y Town#: 16 N Range#: /7 W Town of: lin I 0 r1 o' 1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* o <br /> Tax ID#(l-5 digit number;found on tax statement): c750t<g -I ....... <br /> Proposed Use of Structure/Addition: 1J <br /> Anticipated Start Date:-./''p P• '! .e.):.1,2 ) (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 7- eCD - <br /> Building Contractor: i,'C/ Sewer Installer: w z \^C��) <br /> y V' <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> I tort ckm on $ee4 L <br /> D tie 61, 04.4-- 40 a bed Fee Rec:QOO'12 <br /> us CA rh <br /> e <br /> m <br /> O <br /> z <br /> CA <br /> I > a t.,_, I^ <br /> u u <br /> Date of staff site visit: 7/)3/d-( Initials of 'te visit staff: � f g C ^ <br /> • <br /> PERMIT APPROVED BY ZONING OFFICIAL: filw' DATE <br /> f1�I /��'J/ r-- t U <br /> rn vC CI <br /> m � N Q <br /> Page l of 3 d 3 <br /> Burnett County,WI Land Use Application—Rev 03/2017 a 2 Fill <br /> x <br /> L <br /> m <br />