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LAND USE PERMIT APPLICATION—Burnett County, WI C r <br /> � d <br /> Applicant Complete All Sections Below This Line € J <br /> Permit Types and Fees:(Check appropriate box/boxes) C <br /> m <br /> Dwelling/Principal Budlding-angle Family $300 1 Addition to Dwelling/Principal Burilding-Single Famils $200 g <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings 5200 v O <br /> CommerciaVlndustrial Building 5300 lAddition to Commercial/Industrial Building $200 1 <br /> Accessory Structure(Non-Bunkhouse) 5150 jAddition to Accessory Structure $150 <br /> Bunkhouse 5250 Structural Alteration to Accessory Structure $150 <br /> Accessory Structure-Commercial(CI&11) $200 Addition to Accessory Structure-Commercial(Cl &I I) $200 t �• <br /> Deck/StairstPatio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(l v)) 5350 rn <br /> Campground Structures $125 Filling/Grading $150 <br /> Camping Unit(Six Months Per Year) S100 Boathouse $500 <br /> Permit Extension(Valid for one year-Only 1 Allowed) 5100 � F•p ji1r� S ,c] �- <br /> z <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. ° <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. o <br /> *Items not listed above will be treated as accessory structures,such as:pergo4as,landscaping,etc. b� <br /> Property Owner's Name: ICIRI39$ 3 z <br /> j � O y � <br /> Property Owner's Mailing Address: 1193474, " 5 0 <br /> City State Zip a <br /> Property Site Address: ZQZOO hEEDOM IV f�' <br /> 1 <br /> Contact's Telephone Number: �Z•Z� �,�5�� b <br /> AILLeContact's Email: 1 Jo*KL L(/4D 0- &-f a MAIL- <br /> Legal <br /> gal Description of Property: / <br /> Section#:�Town#: 3 7 N Range#:—LL—W Town of <br /> o <br /> *Attach additional page if needed for lengthy description OR atlach a copy of the deed OR attach tax system property page.* � ' <br /> 1 <br /> Tax ID#(1-5 digit number;found on tax statement): 7,4 3 3 —I <br /> Proposed Use of Structure/Addition: TOKAtSE i <br /> Anticipated Start Date:���� (Home/Cabin;Commercial Business;//Bedroom;Decketc.) d <br /> Building Contractor:WO�� Sewer Installer: /Vf z <br /> N <br /> AREA BELOW THIS LINE LINE RESER D FOR ZONING STAFF COMMENTS/CO TI•IONS ONLY <br /> ZONING STAFF COMMENTS/C 701 pr]ITIONS ONLY <br /> 1(110 P�R1//Y111 10 SUI/1LT.l�.1 1/V ALL COl\'/D1TIONSO 1-1100 TED B LO V; <br /> �Np�?o b� uS�2� �✓' `/ur�ah l7o[�,,TA•7Li�� r F <br /> Fee Rec: Xn,OD <br /> H <br /> �H <br /> v <br /> m <br /> 0 <br /> Date of staff site visit: '� / I Mill f site visit sta <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: <br /> �i <br /> n <br /> m <br /> Page 1 of 3 <br /> Burnett County,WI Land Use Application—Rev 03/2011 <br />