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LAND USE PERMIT APPLICATION - Burnett County, WI a <br /> Applicant Complete All Sections Below This Line �' V <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> Dwelling/Principal Building-Single Family 5300 Addition to Dwelling/Principal Building-Single Family 1$200 — <br /> D,AellingfPrincipal <br /> Building-Multi-Family 5300 Addition to Dwelling/Principal Building-Multi-Family Commercial/industrial Building $300 Addition to Commercial/Industrial Building Accessory Structure(Non-Bunkhouse) $150 Bunkhouse Addition to Ace.Structure $150 Addition to Accessory Structure-Commercial(Cl &I1) I <br /> Accessory Structure-Commercial(Cl &Il) $200 Gazebo(WI Stat 59.692(lv)) S3S0 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Filling/Grading $150 n <br /> Campground Screen Porches $125 Boathouse $500 <br /> Camping Unit(Six Months/Year) $100 <br /> Permit Extension(Valid for one year-Only I 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. 1 ^i P <br /> *Communication Towers&Signs require a different applicationform,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name:fq�O' WAdd `2 `, <br /> Property Owner's Mailing Address: C 'V a <br /> City State d <br /> Property Site Address: It 4 t 1' SU <br /> Contact's Telephone Number: 0&(o.16777 N 0 <br /> Contact's Email: Qand\.rda YICC'X SO COn i�Ary)f5 it. rn <br /> � V <br /> Legal Description of Property: LQTZ 7 1—1Z fig 5. <br /> Section#: Town#: N Range#: W Town of.. y <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* ( 1 <br /> Tax ID#(1-5 digit number;found on tax statement): —� <br /> Proposed Use of Structure/Addition: ds>T� <br /> Anticipated Start Date: (Home/Cabin;Commercial Business:Bedroom;Deck,etc.) <br /> w <br /> Building Contractor: ) _PB7UILSewer Installer: n z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> ft THIS PERMIT IS SUBJECT TO ALL COND TIONS LISTED BELOW: <br /> —�•� �. Fee Rec: <br /> to <br /> � z <br /> Z <br /> Date of staff site visit: Initials of site visit staff: <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE:� � I o <br /> Page 1 of 3 0� <br /> Burnett County,WI Land Use Application—Rev 10/2016 C' <br />