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LAND USE PERMIT APPLICATION—Burnett County, WI _ <br /> N ^ <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Check appropriate box/boxes) �fl <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwt:lling/Principal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) $150 Bunkhouse $250 <br /> o <br /> Addition to Acc.Structure $150 Addition to Accessory Structure-Commercial(CI&Il) $200 <, <br /> Accessory Structure-Commercial(CI &11) $200 Gazebo(WI Stat 59.692(lv)) $350 —, <br /> Deck/Stairs(Patio/Retaining Wall/Sidewalk/Driveway& Filling/Grading $150 0 <br /> 5125 Boathouse $500 <br /> 12 <br /> Camping Unit(Six Months/Year) $100 m <br /> Permit Extension(Valid for one year-Only 1 Allowed) 5100 S i <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> ✓ o <br /> Property Owner's Name: f /�i L G.t/� 1—�-,ol gewl <br /> Property Owner's Mailing Address: <br /> 2o16ztern LAkgVj&MA)ssa a v <br /> /� // City State Zip <br /> �/ p W <br /> Property Site Address: (,`766 G �Gthky, yo <br /> 1 <br /> Contact's Telephone Number: �S 2L / w <br /> 4-1 <br /> Contact's Email: k �+�/!w r'�ii t A4W1Ce/1 fV tl et A U. Gds ago T <br /> Legal Description of Property: / 5l•2. c}.-e� ,� 5. � <br /> Section#: Town#: ange#: W Town of: c U) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> 9 <br /> Tax ID#(1-5 digit number;found on tax statement): z2 99 so (J <br /> f <br /> Proposed Use of Structure/Addition: j7DaK/C*4,,, . <br /> Anticipated Start Date: MA j 20/7 (Nome/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> �t L n � I <br /> Building Contractor: 1 txkpio, BreJ14-s IAAArµ Sewer Installer: NIA z G <br /> y � w <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> TIN1S-PERNUT- IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Fee Reacc <br /> as,Ul� <br /> C " <br /> Z <br /> N rrI <br /> Date of staff site visit: 3 Initials of site visit staff. `S B D 0 <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATEc3—�'' �' l7 O <br /> Page 1 of 3 z <br /> Burnett County,WI Land Use Application—Rev 1/2017 r C' <br />