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LAND USE PERMIT APPLICATION—Burnett County, WI r <br /> a s <br /> Applicant Complete All Sections Below This Line o <br /> Permit Types and Fees:(Check appropriate boxlboxes) a <br /> 0 <br /> w <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family 5200 co <br /> DwellinglPrincipal 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 /> C <br /> Addition to Ace.Structure $150 Addition to Accessory Structure-Commercial(Cl &I1) $200 �. <br /> Accessory Structure-Commercial(Cl &I1) $200 Gazebo(WI Stat 59.692(lv)) $350 0 <br /> DeckiStairs/Patio/Retaining WalllSidewalk/Driveway& Filling/Grading $150 m ' <br /> Campground Screen Porches $125 Boathouse $500 ' <br /> Camping Unit(Six Months/Year) $100 <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 r- <br /> 0 <br /> z > <br /> 0 <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 /> *Items not listed above will be treated as accessory structures,such as:pergolas,landsca in ,etc. <br /> `/J I,!5n <br /> Property Owner's Name: KrV1YIL-"4 N •EY�CkOftel _ <br /> Property Owner's Mailing Address: lq5 Old 35 Mb5ky VV 0. <br /> 1 r�y�r� ;2cad e e��,,� /CQlty State Zip b 1 <br /> Property Site Address: 1��tyG (6wt ;2caA 3✓ . V,cC�w: -r <br /> Contact's Telephone Number: 715-377 -Z55-6:P N °Q <br /> Contact's Email: a wtah uile k �F-Y�Yt raI jar.am - <br /> g � <br /> Legal Description of Property: <br /> Section#: Z8 Town#:_.3q _N Range#: /(0 W Town of: /VI[.G//U✓1 R o <br /> *Attach additional page ifneeded for lengthy description OR attach a copy of the deed OR attach tax system property page.* 1 a <br /> Tax ID#(1-5 digit number;found on tax statement): 3::P-97l <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Dater7--//•f(a (HomelCabi Commercial Business l r000�m;Deck;etc.) r- <br /> Building Contractor:�{�/at/ Sewer Installer: ��/IT-f z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: �j <br /> a MyS� YYl ce fl 1 e c,�C 5�- a[�IC c)•5 ,r� ,t_c>` Fee Rec: I Q� <br /> OV> <br /> G.,��-�e.ss <br /> IM <br /> Date of staff site visit: In' ials of site visit staff: N Z o <br /> 1a a-� 6 <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: Z C <br /> Page 1 of 3 G)Q o_ <br /> Burnett County,WI Land Use Application—Rev 10/2016 Z <br />