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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees.(Check appropriate box/boxes) ° t <br /> o <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 � <br /> Dwelling Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> CommerciaL'Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) $150 Bunkhouse $250 <br /> 0 1 <br /> Addition to Acc.Structure $150 Addition to Accessory Structure-Commercial(Cl &11) $200 <br /> Accessory Structure-Commercial(Cl &11) $200 Gazebo(W 1 Stat 59.692(l v)) $350 <br /> Deck/StairstPatio/Retaining Wall/Sidewalk/Driveway& FillingJGrading $150 <br /> Campground Screen Porches $125 Boathouse $500 a <br /> m <br /> Camping Unit(Six Months/Year) $100 �y <br /> m <br /> Permit Extension(Valid for one year-Only I Allowed) 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 form,see corresponding application and fees. <br /> $100 <br /> *ltems not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> , f �+ ,, l <br /> Property Owner's Name. y y�r�t�'���l1t�31 �N V1V Z <br /> < � x <br /> Property Owner's Mailing Address: �Q� S h o c <br /> City State Zip p <br /> Property Site Address: �]�p /�/f-� q <br /> C+ �24�0 <br /> Contact's Telephone Number: 9 .3 / � �6�:prry S � S N � I <br /> Contact's Email: 1 <br /> Legal Description of Property:it4 C_), �. <br /> Section#: ':� '9 Town#: N Range#: W Town of: 14\ <br /> f•\s eJQX1'3 <br /> o I <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): th�SsNQ�- (,�a: /Qt`f S J41V9 ) <br /> Proposed Use of Structure/Addition: e +C!t A d o,w? -4 w•-d S ter—,evIz- <br /> ER <br /> Anticipated Start Date: (Home/Cabin:Commercial Business:Bedroom:Deck;etc.) r- <br /> m <br /> Building Contractor: Sewer Installer: r) Z <br /> m � <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 4e_� 5 <br /> M o i I x tip Fee Rec:.30� <br /> a VA of �r <br /> \U <br /> Date of staff site visit: Initials of site visit staff: <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: '- <br /> Page 1 of 3 Oa <br /> Burnett County,WI Land Use Application—Rev 10/2016 <br />