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LAND USE PERMIT APPLICATION—Burnett County, WI t~ <br /> C <br /> a � <br /> Applicant Complete All Sections Below This Line a <br /> Permit Types and Fees:(Check appropriate box/boxes) a <br /> Daelling/Principal Building-Single Family $300 1 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 �l O <br /> CommerciaUlndustrial Building $300 Addition to Commercial/Industrial Building $200 t <br /> Y <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> n <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 <. 1 <br /> Accessory Structure-Commercial(Cl &11) $200 Addition to Accessory Structure-Commercial(CI &It) $200 0 <br /> Deck/Stairs/Patio/Retaining WaWSidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 <br /> Campground Structures $125 Filling/Grading $150 � <br /> Camping Unit(Six Months Per Year) $100 Boathouse5500 �y <br /> m <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. $� 1 <br /> *Items not listed above will be treated as acces of structures,such as:pergolas,landscaping,etc. 9 <br /> Jv <br /> Property Owner's Name: + C/C�►Vt �il 3 z <br /> 1'Z '� o y C <br /> Property Owner's Mailing Address: I�tckG7Oc�pyo, t c <br /> r _ e— Iity State , Zip d O <br /> Property Site Address: VZw4(� r�� y l HM <br /> 11 <br /> Contact's Telephone Number: V �Z ��� / Sv <br /> Contact's Email: ��tt �' �/CC�%G �b° t 0' <br /> V o <br /> Legal Description of Property: w r f�'� ►� �'�" l �' " �� r ' 1 1 4 <br /> Section#: _Town#:__!qj�_N Range#:_ W Town of: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* a <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use ofStructure/Addition: I ^ <br /> Anticipated Start Date: (Name/Cabin;Commercial Business;Bedroom:Deck:etc.) <br /> Building Contractor: (�//1/f QA Sewer Installer. h z <br /> X 41 <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY d <br /> THIS PERMIT IS SUBJECT <br /> ^TO ALL CONDITIONS LISTED BELOW: <br /> )c. ' I-S c1,- G! t-hLul f/l�F1SJ��r,� �� <br /> � 0 Fee Rec C <br /> � C 0 <br /> J-� m <br /> MSX C � <br /> Date of staff site visit: Initials of site visit staff: <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE S—� CD 0 <br /> ciig_o <br /> z G'tl1 <br /> Page 1 of 3 c <br /> Burnett County,WI Land Use Application—Rev 03/2017 <br /> X <br /> m <br /> a <br /> m <br />