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LAND USE PERMIT APPLICATION — Burnett County, WI g <br /> Applicant Complete All Sections Below This Line 0' v <br /> Per 't Types and Fees:(Check appropriate box/boxes) <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single roily $200 \ <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 <br /> ro <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> 91 <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 < <br /> Accessory Structure-Commercial(CI&11) $200 Addition to Accessory Structure-Commercial(Cl&11) $200 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 <br /> m <br /> Campgroumd Structures $125 FillinWGrading $150 <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 '�y <br /> m <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three rimes the normal fee. <br /> *Communication Towers&Signs require a different applicationform,see corresponding application and�ees. 't <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a <br /> Property Owner's Name: Q Q t y\_ R) <br /> < y <br /> Property Owner's Mailing Address: _ o <br /> C City State Zip o <br /> Property Site Address: <br /> Contact's Telephone Number: S- -Tl y 7 = t <br /> Contact's Email: <br /> Legal Description of Property: �7 <br /> Section#: pZ(O_Town#:_ N Range#:�c�W Town of: <br /> 93 ^� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage.* ( } <br /> Tax ID#(1-5 digit number; found on tax statement): <br /> Proposed Use of Structure/Addition: � 0� <br /> Anticipated Start Date: 0)�-l 1 01:1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) X <br /> Building Contractor: ?_rA(yc1(xCtrCc�.wS Sewer Installer: z <br /> a <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: K1 <br /> � I , <br /> "75 <br /> Fee ReconD a—) <br /> in <br /> a <br /> m <br /> D <br /> v <br /> Date of staff site visit: Initials of site visit staff: <br /> t.�r Tl <br /> Z dp <br /> PERMIT APPROVED BY ZONING OFFIC DATE:S _ _ 7 N <br /> Page 1 of3 <br /> Burnett County,WI Land Use Application—Rev 03/2/2017 > �� <br /> x <br /> M <br /> fn <br />