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LAND USE PERNUT APPLICATION— Burnett County, NNA C <br /> a _ � <br /> Applicant Complete All Sections Below This Line ; v <br /> Permit Types and Fees:(Check appropriate box/boxes) a <br /> Dwelling(Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 v <br /> DwOling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 an <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> C) <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 <_ _ <br /> Accessory Structure-Commercial(CI&I1) $200 Addition to Accessory Structure-Commercial(CI &11) $200 rn <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 m <br /> Campground Structures $125 Filling/Grading $150 <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 <br /> ro <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. ° <br /> *Communication Towers&Signs require a dilerent applicationform,see corresponding application and ees. " <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. II <br /> p � n <br /> Property Owner's Name: r dc r-(,_) z <br /> Property Owner's Mailing Address: a <br /> P nY g `�S Nt C3'f3e ♦ I'll ry 533 c <br /> City State Zip <br /> Q o <br /> Property Site Address: (OLk3 G s'0�er R.} D4,��r <br /> Contact's Telephone Number: (e 2 `8145 — ,S ZD jo c b <br /> t- o t <br /> —Contact's Email: �p�v.�� ^�4m �JcG-r%_a_r - C-ov — I J d <br /> Legal Description of Property: L� J y a�`!�I <br /> Section#: c) Town#: t O V N Range#: I W Town of: n t , <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: vsGC.e569r^1 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Dec ;etc.) x <br /> Building Contractor: Sewer Installer: y z <br /> N <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> — M ., 54 b e__ OA I 5�' 3 0' -�o �� <br /> k 1 ` o <br /> v 5 v �� ���a, 1 + �rt`nt Fee Rec: Jr <br /> -3o ; 17 ' 6 X <br /> 10 -31 <br /> Date of staff site visit:_ 1 y <br /> 6 � � � �� Initials of site visit staff: <br /> PERMIT APPROVED BY ZONING OFFICLAL: JK� DATE:�� <br /> n <br /> Page 1 of 3 = <br /> Burnett County,WI Land Use Application—Rev 03/2017 <br />