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LAND USE PERMIT APPLICATION — Burnett Countv. WIr <br /> a ct <br /> Applicant Complete All Sections Below This Line 7' v <br /> Permit Types and Fees:(Check appropriate box/boxes) ° <br /> O <br /> DwellingTrincipal 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 v <br /> Commercial/Industrial Building $300 1 Addition to Commercial/Industrial Building $200 I <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> n <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 -15 <br /> Accessory Structure-Commercial(CI & 11) $200 Addition to Accessory Structure-Commercial(Cl &11) $200 <br /> / Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 m <br /> ' Campground Structures 3 <br /> P@' $125 Filling/Grading $150 <br /> w <br /> Camping Unit(Six Months Per Year) $100 1 Boathouse $500 �.o <br /> m <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 application form,see corresponding application and fees. Er <br /> 0 <br /> *Items not listed above will be trea as accessory structures,such as:pergolas,landscaping,etc. Cn <br /> o <br /> Property Owner's Name: z <br /> 2. <br /> Property Owner's Mailing Address: IX V Cl a v <br /> � <br /> / �ty/1 State Zip <br /> � d <br /> Property Site Address: zz -Z,L/item `(77 J r� <br /> Contact's Telephone Number: - /45-`�9:O - Cj�-� [ o <br /> Contact's Email: d F�(if ISI l Q•�1/� CO /Y j <br /> Legal Description of Property: S <br /> Section#: (:2q Town#: N Range#j/e:57_W Town of: /):� ��� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page. <br /> �9 1�j Tax ID#(1-5 digit number;found on taxxn stJateem�ent): 8�� y <br /> Proposed Use of Structure/Addition: /`t�n a S 1--Lo ek' � <br /> Anticipated Start Date: (Home/Cabin;Commercial Busir ss;Bedroom;Deck;etc.) or ) <br /> Building Contractor: Sewer Installer: y z <br /> y <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> jo <br /> Fee Rec: O <br /> �i <br /> Vi <br /> N <br /> M <br /> - m <br /> O <br /> z C 0 <br /> Date of staff site visit: Initials of site visit staff: a Z <br /> M 'h <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: L F � ' ` h cri °n <br /> N e"X <br /> 650 o Gt <br /> Page 1 of 3 o Z <br /> Burnett County,WI Land Use Application—Rev 03/2017 <br /> a <br /> x <br /> m <br /> Eii <br />