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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> a <br /> Applicant Complete All Sections Below This Line a' <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling Principal Building-Single Family $200 \ <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 O <br /> Commercial/Industrial Building $300 Addition to CommerciaUlndus[rial Building $200 rj <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 1 Addition to Accessory Structure-Commercial(Cl &11) $200 <br /> Deck/Stairs/Patio/Retaining WaIL'Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 iv <br /> Campground Structures $125 Filling/Grading $150 '— <br /> w <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 <br /> -o <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 <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 different applicalionform,see corresponding application andfees. <br /> o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. °aa <br /> Property Owner's Name: /t icA44✓2 o LSI,u 1, � z <br /> O y <br /> Property Owner's Mailing Address: /-96290 s ifo , ((lit-, S T rCCcct f-nrz <br /> City State Zip s�ylv8' o <br /> Property Site Address: ry SS try /9j F 4*t1 act i2 y <br /> Contact's Telephone Number: to cz- - /-7 / c w <br /> Contact's Email:1114,t n _ e mj_5 //L <br /> N <br /> Legal Description of Property:L,6r 2 C45F t-ri 4 k, 914i4 W 3772 A)LL" <br /> s �34.7,/.5 � <br /> Section#: ''03 Z-Town#: WIN Range#: i`�W Town of: $W 15 S .3 o� 3s'7S?9 v <br /> 0 <br /> Af <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage.* ( 1 <br /> •if ZZZO•( d <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: STV12&4!j rL <br /> Anticipated Start Date: <br /> �J /It U (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) O <br /> Building Contractor: Sewer Installer: A14 � <br /> y z <br /> N <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY d <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Fee Rec: e� <br /> �i <br /> N <br /> a <br /> m c� <br /> n <br /> _Za-� y n <br /> Date of staff site visit: c. � Initials of site visit staff "'o ITI <br /> PERMIT APPROVED BY ZONING OFFICIAL: r t DATE ®{ v <br /> m C: o <br /> Page 1 of3 o Z <br /> Burnett County,WI Land Use Application—Rev 03/2/2017 <br /> 9 <br /> S <br /> m <br /> m <br />