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LAND USE PERMIT APPLICATION — Burnett Countya <br /> , WI b <br /> Applicant Complete All Sections Below This Line 0' <br /> a ' <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> d <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 K <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 <br /> O <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> L7 <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 < I <br /> Accessory Structure-Commercial(CI&11) $200 Addition to Accessory Structure-Commercial(Cl &I I) $200 c <br /> Deck/Stairs/Patio/Retaining Watl/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 Gn <br /> Campground Structures $125 Filling/Grading $150 <br /> w <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 `7 <br /> b <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 r, <br /> o <br /> z <br /> *NOTE:After-the-Fact(when no permit is obtained prior to construction)is up to three times the normal fee. o ' <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. o <br /> � A <br /> Property Owner's Name: M chae I E. r- ULLim- F Mc Lc,,k I t'i'1 7z <br /> WI C <br /> Property Owner's Mailing Address: lI yO l ;�� #3 OAHOP&As_ a <br /> City State Zip <br /> Property Site Address: Z�O(n, S/-c1 1,2 12d- 9ST Da Yl 6 ULV i l u Z SZ/ 36 <br /> i <br /> Contact's Telephone Number: ']/S- S 7 7--J b 3 Z —7i S- (y S/ - 9 <br /> Contact's Email: Q UsIu vas un C/lat4er. i 1P_ p <br /> y <br /> Legal Description of Properly: S'¢p a CHe� <br /> w <br /> Section#: Town#: 40 N Range#:__&o _W Town of: 1)Qh.b U►V y <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number;found on tax statement): 13071 .� <br /> 1 <br /> Proposed Use of Structure/Addition: de)M e- <br /> Anticipated Start Date: 4-05-ri (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> m ) <br /> n <br /> Building Contractor: M;ke AAeLat4hSewer Installer: &je, Qufs{1o1rrl z <br /> w <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> O VSA { e"C_ O.- GS1\N �fl k.1c9 +0 Fee Rec3�0_0a) <br /> CN <br /> v <br /> M <br /> z � <br /> C <br /> y D � <br /> l —o <br /> Date of staff site visit: L — Initials of site visit staff: —sio 111 <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: LI— 5 — C) (� <br /> s <br /> Page 1 of 3 <br /> Burnett County,WI Land Use Application—Rev 03/2017 <br /> z <br /> m <br /> a <br /> m <br />