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LAND USE PERMIT APPLICATION — Burnett County, WI a ro <br /> Applicant Complete All Sections Below This Line <br /> I <br /> Permit Types and Fees:(Check appropriate box/boxes) r� n <br /> 1 d <br /> DwellinePrincipal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 g <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> C) <br /> Bunkhouse $250 11 Struct ral Alteration to Accessory Structure $150 < ` 76 <br /> Accessory Structure-Commercial(Cl & 11) $200 Addition to Accessory Structure-Commercial(CI &II) $200 c <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 y <br /> w <br /> Campground Structures $125 Filling/Grading $150 '— <br /> v <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 <br /> v <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 ,S} <br /> * ` ' o <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. o <br /> *items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. D <br /> y <br /> Property Owner's Name: 6S r�(J'�� /� / 4 <br /> o � � <br /> Property Owner's Mailing Address: d t w c ) <br /> City State zip d <br /> Property Site Address: 2 7 �TT�I/C�I! (0,7 LIC AO Si '9 . N-I D149" <br /> Contact's Telephone Number: of �ai! f 1�7[�yo , <br /> 0 <br /> 5' <br /> Contact's Email: <br /> 0 <br /> N <br /> 1 <br /> Legal Description of Property: <br /> Section#:a Town#: N Range#: 1_W Town of: �fQz <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* l l^( t 1 <br /> �J I <br /> Tax ID#(1-5 digit number; found on tax statement): 14.744 <br /> Proposed Use of Structure/Addition:��G�� <br /> Anticipated Start Date: (Nome/Cabin;Commercial Business;Bedroom:Deck;etc.) <br /> Building Contractor: Sewer Installer: n <br /> � z I <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:1 <br /> x <br /> (A <br /> y <br /> M <br /> m <br /> O <br /> zU3c <br /> Date of staff site visit: I itials o site visit staff: M C <br /> PERMIT APPROVED BY ZONING OFFICIAL• DATE: <br /> m <br /> ® u <br /> Page 1 of 3 c <br /> Burnett County, WI Land Use Application—Rev 03/2017 a <br /> 3 <br /> x <br /> M <br /> a <br /> m <br />