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LAND USE PERMIT APPLICATION- Burnett County, WI g c <br /> N <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Check appropriate box/boxes) ° I <br /> m <br /> —Dwelling/Principal Btilding-Single Family $300 1 Addition to Dwelling/Principal Building-Single Family $200 n^ <br /> DwellingTrincipal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 n <br /> t t7 <br /> Commercial/Indwtrial Building $300 Addition to Commercial/Industrial Building $200 <br /> ti <br /> t/ Accessory Struettre(Non-Bunkhouse) $150 Addition to Accessory Structure $150 ) <br /> 0 <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 <br /> Accessory Structure-Commercial(Cl &11) $200 1 Addition to Accessory Structure-Commercial(Cl &11) $200 0 <br /> �, <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/DrivewayGazebo(WI Stat 59.692(lvp $350 <br /> & �I m ' <br /> Campground Structures $125 Filling/Grading $150 <br /> Camping Unit(Six Months Per Year) $100 1 Boathouse $500 <br /> 0 <br /> Permit Extension(Valid for one year-Only I Allowed) $100 r` <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 require a different application farm,see corresponding application and fees. m <br /> °o <br /> *Items not listed above will be treated as accessorystructures,such as:pergolas,landscaping,etc. <br /> L I '- w W <br /> Property Owner's Name: 7ko m a y He iy11 rl E(Z 3 2 <br /> Property Owner's Mailing Address: 4401 3`4'h Alm, �� S+i "�BN M N �T2 l e o <br /> o City State Zip v <br /> Property Site Address: (03,13 C lirG I e_ Rd 19A(k Ihttvy SIV Z 5 3 U <br /> --I / I <br /> Contact's Telephone Number. IioS(-aI P 0 q F� <br /> Contact's Email: -{'t�Ztf kMW Pg rwa l L-, "W' o <br /> I y. <br /> �/ <br /> Lof I CW 14 PI 3 (At 39'%46 (&OV LOT 5 <br /> Legal Description of Property: 9 <br /> Section#: at.. Town k 40 N Range#: /(* W Town of: baK( Ih l) ! <br /> o "� <br /> *Attach additional page if needed far lengthy description OR attach copy of the deed OR attach tax system propertv page.' <br /> Tax ID#(1-5 digit number;found on tax statement): /a slo <br /> Proposed Use of Structure/Addition: 6alKag-C <br /> Anticipated Start Date: Spit 2011 pendw G (Home/Cabin;Commercial Business:Bedroom;Deck;etc.) t� <br /> Building Contractor: Ryul l o� Sewer Installer: �( <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT I`S- SUBJECT TO ALL CO tN-DITIONS LISTED BELOW- <br /> I <br /> 1 4 / 1 p <br /> N Fee Rec: <br /> e,t e <br /> {oa � <br /> s t� ,�, C z ryc.�'v 6 � � <br /> Date of staff site visit: Initials of site visit staff: <br /> Z <br /> N M r- <br /> PERMIT APPROVED BY ZONING OFFICIAL: —" DATE:1--) 3^ mz0 <br /> :1 <br /> V i� U U <br /> N C� <br /> Page 1 of 3 0C o <br /> Burnett County,WI Land Use Application—Rev 03/2017 z [� <br />