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LAND USE PERMIT APPLICATION— Burnett County, WI <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Check appropriate box/boxes) e a <br /> b <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Famil $200 <br /> Dwelling/Principal Building-Multi-Family $300 1 Structural Alteration to Dwelling/Principal Buildings 0 <br /> CommercialAndustrial Building $300 Addition to Commercial/Industrial Building $200 Z[ i <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 l(� <br /> 1 <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 <br /> Accessory Structure-Commercial(CI &I1) $200 Addition to Accessory Structure-Commercial(CI &11) $200 .+ o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(tv)) $350 L CA <br /> Campground Structures $125 Filling/Grading $I50 <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 .a <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 r. <br /> o_ <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to th ree times the normal fee. ° <br /> zy 1 <br /> *Communication Towers&Sighs require a different application form,see corresponding application and fees. g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a <br /> m <br /> Property Owner's Name: Mark Heverly <br /> N <br /> Property Owner's Mailing Address:_2279 Segundo Ct#4 Pleasanton CA 94588_ c <br /> City State Zip o <br /> Property Site Address: 2823 County Rd A Webster WI 54893 <br /> S <br /> Contact's Telephone Number: 925-683-1418 n <br /> Sbe <br /> s <br /> w <br /> Contact's Email: mheverly@comcast.net b <br /> N <br /> Legal Description of Property:_W 1/2 Lot 7-Lots 8-9 Oak Lake Add#I S 1/2 Wood land prkwy <br /> Section#:_20_Town#:_40—N Range#:_14_W Town of: Scott y <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 1 <br /> Tax ID#(1-5 digit number;found on tax statement):-19138 a , <br /> Proposed Use of Structure/Addition:_Home addition <br /> Anticipated Start Date:—June (Horne/Cabin;Commercial Business;Bedroom;Deck:etc.) - 1 <br /> Building Contractor: Northland Builders Inc_ Sewer Installer: NA y 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 /> Fee Rec:��r� <br /> H <br /> N <br /> a <br /> M <br /> N <br /> O <br /> _ n <br /> C H^ <br /> Date of staff site visit: _ I Initials of site visit staff: `� H M Y17lYrlYt <br /> LI <br /> PERMIT APPROVED BY ZONING OFFICIAL:�rN DATE: / a0 �t tp j <br /> ti <br /> Pagel of 3 0 � <br /> Burnett County, WI Land Use Application —Rev 03/2017 G� <br />