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LAND USE PERMIT APPLICATION — Burnett County, WI c <br /> a <br /> b <br /> Applicant Complete All Sections Below This Linc <br /> Permit T.v7s and Fees:(Check appropriate box boxes) <br /> 0 <br /> Dwelhng/Pnncipal Building-Svngle Family 5700 Addition to ri elling/Principal Building-4ngle Famil} $200 <br /> Dwclling/Principal Building-Multi-Family 5300Slruct ttnl Alteration In Dwelling Principal Buildings 5200 <br /> Cnmmerciallndustrial Building 5300 Addison to Commercial Indmlrial Building 5200 <br /> Acceszsory Slructtre(Non-Bunkhouse) $ISO Addition to Accessory Sirwlwc SISo <br /> o <br /> Bunkhouse 5250 9ructtpal Alteration to Accessory Slructuae SISB <br /> Accessory Sirwtune-Commercial(CI &11) $200 Addu ion to Accessary Strucsre-Commercial ICI &I1) $200 p <br /> 2. <br /> Deck,Stairs/Pano/Retaining WalVSidcvrslk/Driveway& Gazebo(W l Slat 59.692(1 v)) $350 <br /> v <br /> CampgJotmd Structures5125 Filimg�Ciradtng SI50 <br /> Camping UNI(Six Months Per year) $10(1 naathouce SSDO y <br /> Permit E><tcnsioo(Valid for one year-Only I Allowed) 5100 r. <br /> o = <br /> _ <br /> *NOTE After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. , Zp a <br /> m <br /> ammurticattnn Tawers&Signs require a different application farm,ser mrrerponding appliranon and finer. <br /> 'hem r not listed ubure%ill be treated us a(res.sory sUuchirm, such us petgolimlandscripurq,etc. a <br /> _ d n <br /> n <br /> Property Owners Name: I� H17 7021.. i-.J1-//1- /A✓�i�D�G <br /> / < z <br /> Property Owner's Mailing Address: 5� o Lrl.✓� MirJ r/� R <br /> City State Zip <br /> Property Site Address: A? 4} et <br /> ootact's Telephone r77._ <br /> Contact's Email: <br /> Legal Description of Property:PZ�.` O7— QPZLodi <br /> Section#: Town#: N Range#: W Town of: / <br /> o � <br /> *Attach additionalpage ijnerdevlJw�lengthy description OR attach a copy � <br /> py of the deed OR attach tar syst <br /> r property page.• , � E ( �'�, <br /> II <br /> Tax ID#(1-5 digit number, found on tax statement): <br /> Proposed Use of Structure/Addition: <br /> r - <br /> Anticipated Start Date: wrE 1r - (Home/C'abinr Commercial Business;Bedroom:Deck:etc.) it <br /> Building Contractor: ( � ( NLizeL z2C- Sewer Installer: N �J <br /> z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY Iy A <br /> THIS PERMIT 1S SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Fee Rec: <br /> r <br /> v <br /> c <br /> M <br /> N <br /> 7. <br /> Date of staff site visit: J Initials of site visit Staff: �� > c ►j <br /> Z C <br /> �J o® z <br /> PERMIT APPROVED BY ZONING OFFICIAL: - DATE: - � / Az v <br /> CZ® Q C' <br /> Page 1 of 3 0 z ti �I•lf <br /> Burnett County,WI Land Use Application — Rev 03/2017 <br /> >e <br /> m <br />