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LAND USE PERMIT APPLICATION - Burnett County, WI M <br /> b <br /> Applicant Complete All Sections Below This Line <br /> 9 71 <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 S <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 Z JI <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 ^ 9jt <br /> Accessory Stna:ture(Non-Bunkhouse) $150 Addition to Accessory Structure $150 i <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 ` <br /> Accessory Structure-Commercial(CI &II) $200 Addition to Accessory Structure-Commercial(CI &11) $200 c <br /> Deck/Stairs(Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 N w <br /> Campground Structures $125 Filling/Grading $150 <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 .a <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 \ S 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 diferent application form,see corresponding application and fees. <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a <br /> =• �n <br /> Property Owner's Name:l)r\01 3 (Q, <br /> w F in <br /> Property Owner's Mailing Address: t;Y 5 ^lac sn ri5 i A pml an d If c <br /> l City State Zip o <br /> Property Site Address; 9, 7 1 b� 1z-E -7 2 r] <br /> Contact's Telephone Number: G ,2- 2 3- 4 112. <br /> 0 N <br /> Contact's Email: �v L ,LIQ rACr MS io. Cc V-^ d r <br /> 7. <br /> Legal Description of Property: 1F11,b tr l G16& 51, ka¢ i o a o, . 12 I I K <br /> Section#: Town#: 4 0 N Range#: /b w W Town of: D pV k 1 <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* W 7 <br /> Tax ID#(1-5 digit number; found on tax statement): `3 3 4 3 / -1 <br /> Proposed Use of Structure/Addition: Cl()'Jqq 0 <br /> Anticipated Start Date: 5-�a E I (Home/Cabin;Comnlercial Business;Bedroom;Deck;etc.) x Y <br /> Building Contractor.' `C 4Q ec,� Sewer Installer: 01(.1 y z <br /> y <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: o <br /> Ma X ��� ► w `'��s <br /> ' Fee Rec: � <br /> bl� �-� �� Sack z <br /> O C _S � c s��rs , 2, to <br /> CC C C c <br /> Date of staff site visit: �'J _ Initials of site visit staff: J _ mN Z n 0 u U <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: �� r <br /> 0 r . <br /> Page 1 of 3 c Z <br /> Burnett County, WI Land Use Application—Rev 03/2017 > �� <br /> m <br /> a <br /> m <br />