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LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line <br /> Permit Types andFees:(Check appropriate box/boxes) a a <br /> O <br /> Dwelling/Principal Building-Single Family $300 Addition to Deelling/Principal Building-Single Family $200 n <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 <br /> 1 <br /> CommerciaUlndustrial Building $300 Addition to Commercial/Industrial Building $200 � <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> o � f <br /> Bunkhouse $250 iStrucnaal Alteration to Accessory Structure $150 <„ <br /> Accessory Structure-Commercial(Cl & Il) $200 Addition to Accessory Structure-Commercial(Cl &11) $200 1 C <br /> � Q tar f o-< YS � Gazebo(WI Stat 59.692(lv)) $350 <br /> DecPowd <br /> atio/Relaining Wall/Sidewalk/Driveway& <br /> X CamStructures $125 Filling/Grading $150 <br /> w <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 <br /> rn <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 r. <br /> c - <br /> *NOTE:Aker-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. o <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. b <br /> n <br /> Property Owner's Name: S h Y nsl a c tJ A e- i = <br /> Property Owner's Mailing Address: ,;2n tAii SStI i 3 y <br /> a <br /> City State Zip <br /> Property Site Address: k O 9CA c'-r4 QC\ <br /> Contact's Telephone Number: _ G S ( - / vZ 6 - t-{ <SIS cl o <br /> 0 <br /> Contact's Email: COM 00%_000 o 1 <br /> maT 5 <br /> Legal Description of Property: Sie_ Faxria�aiN 1.0T t C`3lrA %J3, Q35 <br /> NCTT <br /> Section#:—,cAq Town#: 140 A) N Range#: L4 W Town of: l SVoa 0V!N_ GQu Mly LQI_ <br /> < \ o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Tax 1D#(1-5 digit number;found on tax statement): b 5 Q 3kn <br /> uJooO Theta STepS 1 <br /> Proposed Use of Structure/Addition: STe T!S T n OC)0_V_, Q\a'*1;�a c tr -Ce BOG r <br /> Anticipated Start Date: S —lx- ♦'} (Home/Cabin;Commercial Husiness;Hedroom;Deck;etc.) <br /> ` � 1 <br /> Building Contractor: p� '1 o e'-S r X t�%J art N l��ryewer Installer: y Tz O <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> y ry <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> ��^ I- 1 r,f ❑ 1 FeeReJas-.( <br /> H <br /> O <br /> t'1 <br /> C <br /> Date of staff site visit: v ^ Initials of site visit staff: c <br /> 1 o N — <br /> om <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE:�! z w <br /> 3� <br /> m GO o <br /> Pagc 1 of 3 0 I <br /> Burnett County, WI Land Use Application—Rev 03/2017 <br /> m <br /> A <br /> m <br />