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LAND USE PERMIT APPLICATION — Burnett County, WI a C <br /> Applicant Complete All Sections Below This Line v <br /> Permit Types and Fees:(Check appropriate box boxes) ° <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 \ K <br /> DwellingTrincipal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 <br /> Commercial/Industrial Building Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> M <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 °< <br /> Accessory Structure-Commercial(Cl&11) $200 Addition to Accessory Structure-Commercial(Cl &11) $200 <br /> Deck/Stars/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 w <br /> Campground Structures $125 Filling/Grading $150 3 <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 <br /> —> <br /> Permit Extension(Valid for one year-Only 1 Allowed)P100 <br /> z <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 dilerent applicationform,see corresponding application andfees. M <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> w C1 <br /> Property Owner's Name: A�7�1[.c ,P �. . _�/i7//L� , �G I ✓.�-/✓ 7 `z <br /> o � <br /> Property Owner's Mailing Address: / (� - cS Sr v Q <br /> City State Zip o <br /> Property Site Address: See #44i n tete sl(ake, RJ, -7: a <br /> Contact's Telephone Number: <br /> w' <br /> Contact's Email: olrb�2t �� 1� • n p, 0 1 <br /> Legal Descripti n of Property: S ` <br /> Section#: Town#: N Range#: W Town of `� a <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* c <br /> Tax ID#(1-5 digit number;found on tax statement): -1 <br /> Proposed Use of Structure/Addition: t- <br /> Anticipated Start Date: ome/Cabin;Commercial Business`;Bedroom;Deck etc.) � a <br /> Building Contractor: Sewer Installer: z <br /> SON <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO 1ALL CONDITIONS LIST1ED BELOW: <br /> [D+O,"o, I v, S��� , c AA v-e_s s <br /> py-� <br /> b ��t�%�rul tv�r�'erS ,,�1`��c <br /> Fee Rec:�m l oc <br /> �J a <br /> rn <br /> Z t <br /> Z <br /> C <br /> Date of staff site visit: L� l Initials of site visit staff- s�l Z z <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: I— g v <br /> CO o <br /> Page 1 of 3 0 C <br /> Burnett County,WI Land Use Application—Rev 03/2017 n� <br /> m <br /> �i <br />