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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> a � <br /> Applicant Complete All Sections Below This Line R ~ <br /> Permit Types and Fees:(Check appropriate boxJboxes) <br /> 6 <br /> d <br /> lhwilin�tBuilding-Single Family y $300 1 Addition to Dweltin g/Puicipal Buildeg-Single Family 5200 p° <br /> g <br /> Dmlling/Pmopud Building-Multi-Family $300 Structural Alteration to DwI ing/Principal Building, 5200 O <br /> CommerciaVlndrstrial Building $300 Addition to Commercial/Industtial Building 5200 ,I <br /> Accessory Struclure(Non-Bunkhouse) MSO Addition to Accessory Structure $150 <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 <br /> Accessory Structure-Commercial(Cl&11) $200 Addition to Accessory Srueture-Commercial(Cl&Il) 5200 e <br /> Deck/StairsiPatio/Mainntg Wa i Sideuulk/Driveney& Caaho(WI Stat 59.692(lv)) 5350 <br /> ti <br /> Campground Structures $125 FfflmgU admg $150 <br /> Camping Unit(Six Months Per Year) $100 Boathouse 55110 <br /> re 04 <br /> Permit Extension(Valid for one year-Only 1 AUoved) $100 0 <br /> 5 <br /> 'NOTE:After-the-fad(when no permit is obtained prior to uxmstmetion)is up to three times the normal fee. 9 CCCC�fff/tttt <br /> *Communication Towers&Signs require a d*rent application,form,see aorrespardarg aplobca ion and hes. 1 <br /> •Items not listed above will be treated as accessory savctrrres,such as:pergohn,hutdreaping etcrA <br /> a <br /> Property Owner's Name:Z,44E/Z e01 <br /> CJAr <br /> C w a <br /> Property Owner's Mailing Address: Z <br /> City Zip ^Qu d <br /> Property Site Address: 3 z f "4A_1 -� (� <br /> Contact's Telephone Number: <br /> Contact's Email: <br /> C r1 L <br /> Legal Description of Property: S� <br /> Section#: Town#: N Range#: W Town of 4�n� <br /> 'Attach additional page jneeded jot lengthy description OR attach a copy of the deed OR attach tax system property page.• ( I t a �� <br /> Tax ID#(1-5 digit number,found on tax statement): 7zG7 .t �,Ch <br /> Proposed Use of Structure/Addition: 2j�t'0,tom e� t e_ ��g�/i} I X D-0 <br /> Anticipated Start Data:- - iI #f (Ho Cabin,Commercud Business,Bedroom;Deck;etc.) `P 1 <br /> Building Contractor: Sewer Installer: /Ltd z,_ff z 0 <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTSICONDITIONS ONLY • <br /> TMS PERMIT IS/SUBJECr TO ALL CONDMONS LISTED BELOW: <br /> IlProvtd '11101 <br /> Fee Rec: <br /> in <br /> m <br /> 0 <br /> m <br /> N <br /> O <br /> H <br /> Date of staff site visit: S'-2"/7 In! Lc of she v it staff: C <br /> Da <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: S- I ' I 1 � Z� D <br /> _ <br /> Page 1 of 3 9 8 o <br /> Burnett County,WI Land Use Application-Rev 03/2017 <br />