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LAND USE PERMIT APPLICATION - Burnett County, WI a C <br /> Applicant Complete All Sections Below This Line n <br /> Permit Types and Fees:(Check appropriate box/boxes) C7 <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> K <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 /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 ~ <br /> o =z <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 <br /> Accessory Structure-Commercial(Cl&11) $200 Addition to Accessory Structure-Commercial(Cl &11) $200 0 <br /> Deck/Stairs/Patio/Retaining WalUSidewalk/Driveway& Gazebo(W!Stat 59.692(lv)) $350 <br /> Campground Structures $125 Filling/Grading $150 ' <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 0 _ <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 Taxers&Signs require a different application form,see corresponding application and fees. 5' <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. 21a <br /> w C] <br /> Property Owner's Name:(), III a M 1141.Ce, D O nim D G V t c <br /> 2. <br /> a <br /> Property Owner's Mailing Address: 5 4)t <br /> City Sta e Zip d <br /> Property Site Address:A 5:A,5-1 ebzt&l ( )[//Dg4 A/ <br /> i , <br /> Contact's Telephone Number: _/5 h-9- !2/ 7 <br /> 0 <br /> 5' <br /> Contact's Email: m�,nF✓cam �T�m�t j °.Dm t7 <br /> 3. <br /> Legal Description of Property: <br /> Section Town Range W Town of: S C o 7 7 <br /> a li <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach ter system property page. <br /> Tax ID#(1-5 digit number;found on tax statement): / 17 (o g / (/)11 --1 � <br /> Proposed Use ofStlucture/Addition:Cjn IP )~N Po RGI{ K��4Gewx�t\T <br /> Anticipated Start Date: (Home/Cabin:Commercial Bt siness:Bedroom:Deck:etc.) <br /> C� <br /> Building Contractor: Sewer Installer: N z <br /> zj <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> n o_1A_ -74� 6e a �j 7<o r1 qt, , A <br /> 5�`Gal/C//ate!e d � II.- SS �/ �S��1'l� �G✓`LT� po'q� <br /> Fee Rec:�=.'+� l/ <br /> 7%e. ge✓A qK4N4✓l <br /> 6 <br /> �i✓IM tt t (o u I td t_Ej� <br /> z <br /> C <br /> Date of staff site visit: �[ d�J Initials of site visit staff: c:_A� n Z <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: L��J�'� ►�+ r�r <br /> r <br /> Page I of 3 0 <br /> Burnett County,WI Land Use Application—Rev 03/2017 > �t <br /> z <br /> m <br />