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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line a J <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/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 /> 0 <br /> Addition to Ace.Structure $150 Addition to Accessory Structure-Commercial(Cl &11) $200 <br /> Accessory Structure-Commercial(Cl &11) $200 Gazebo(WI Stat 59.692(l v)) $350 r <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Filling/Grading $150 w <br /> Campground Screen Porches $125 Boathouse $500 <br /> m <br /> Camping Unit(Six Months(Year) $100 <br /> 0 <br /> ro <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 S <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 strucnu es,such as:pergolas, landscaping,etc. <br /> C] <br /> Property Owner's Name: 6rvan } * Vb p Wrrf 3 z <br /> fri gvwj n C 6I 1 n (� �7 y '� J <br /> Property Owner's Mailing Address: Yi Pj 0t / c <br /> City State Zip p <br /> Property Site Address: <br /> J <br /> Contact's Telephone Number: �!5-O—H 3 q e t2 <br /> Contact's Email: No o N 'e, <br /> UjluCOt <br /> Legal Description of Property: 5e e. <br /> Section#: Town#: N Range#: W Town of: 2y.% ss c 10 C <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system property page.* 0� oi un� <br /> Tax ID (1-5 digit number;found on tax statement): a 331 i R D 3 701 Propose Use of Structure/Addition: O C <br /> Anticipated Start Date: (Home/Cabin:Commercial Business;Bedroom;Deck;etc.) r J <br /> Building Contractor: Sewer Installer: n z <br /> W <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Fee Rec• s <br /> VJt1c>(\ �¢� tfS b 1L TO G�SS4SS S lTt, C�6Y��i`TL*6S pob��prw <br /> c,0,\/aJ l pY-N Op <br /> &AVow w: ray Sar.cn c_ (`eVte�✓ C <br /> � Z m <br /> 2 <br /> Date of staff site visit: �' C)— Initials of site visit staff: �y z 1 <br /> 20 <br /> O o <br /> PERMIT APPROVED BY ZONING OFFICIAL DATE: a= ( O Z ti <br /> Page 1 of3 <br /> Burnett County, WI Land Use Application—Rev 10/2/2016 �„� <br />