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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line ?' 6- `+ <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> J <br /> 0 <br /> Dwelling/Principal Building-Single Family 5300 Addition to Dwelling/Principal Building-Single Family f$200 <br /> n <br /> DwellinpJPrincipa]Building-Multi-Family $3110 Structural Alteration to Dwellinp./Principal Buildings <br /> CommercialIndustrial Building <br /> $300 Addition to Commercial'lndustrial Building ) <br /> Accessory Structtre(Non-Runkhouse) 5150 Addition to Accessory Structure 0 <br /> �' I <br /> Bunkhouse 5250 Structural Alteration to Accessory Structure < <br /> Accessory Structure-Commercial(Cl&I I) $200 Addition to Accessory Structure-Commercial(Cl & 11) <br /> beck/StairsTatioiRetaining WaILSidewalk,,Driveway& Gazebo(WI Stat 59.692(l v)) <br /> Campground Structures 5125 Filling/Gading • <br /> Camping Unit(Six Months Per Year) 5100 Roathouse b <br /> Permit Extension(Valid for one year-Only I Allowed) $100*NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. <br /> •Communication Towers&Si s r uire a di erent lication orm•see corres ondirs gn e4 .� t+PP I P g application and fees.•Items not listed above will he treated ar accessory structures,such as:pergolas.landscaping,etc. <br /> Ll <br /> Property Owner's Name: SO z <br /> -� Property Owner's Mailing Address: (;)C&7 8 A N o I iv c vi <br /> City State Zip v <br /> -� Pro 7 <br /> Property Site Address: � ri15r(=.jTQ' / L�l NO t Ny <br /> Contact's Telephone Number: <br /> Contact's Email: g f rJ!AL. 1774E L-G T t f GiY7AlL <br /> Legal Description of Property: <br /> Section#: 0 1 Town#:�2N Range#:��W Town of T� e, e- � <br /> II <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* LQ) a <br /> I 1 <br /> Tax ID#(1-5 digit number;found on tax statement): !;7-Rs W-d- 7-/A -A -j /S- y3 P -0,.Z -1 <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: '- (Home/Cabin:Commercial Business:Bedroom:Deck,etc.) <br /> n <br /> Building Contractor:���� �.�tslo,-,.����G�.�tsib,-,.����G- Sewer Installer: P/.4 <br /> a <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> o.Y)d Fee Rec: I J O <br /> H <br /> 6 <br /> m <br /> 0 <br /> z <br /> 0 <br /> Date of staff site visit: Initials of site visit staff: <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE:v -f b_ I Z� r+ <br /> P. <br /> CD <br /> Page 1 of 3 <br /> Burnett County,WI Land Use Application—Rev 03/2017 <br />