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LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line a <br /> Permit Types and Fees:(Check appropriate box/boxes) n <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 O <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 1 <br /> Accessory Structure(Non-Bunkhouse) $150 Bunkhouse $250 <br /> o !T <br /> Addition to Ace.Structure $150 Addition to Accessory Structure-Commercial(CI &Il) $200 It. 1 U <br /> Accessory Structure-Commercial(CI &II) $200 Gazebo(WI Stat 59.692(lv)) $350 0 <br /> Deck/Stairs/Patio/Retaining WaU/Sidewalk/Driveway& Filling�Caading $150 <br /> Campground Screen Porches $125 Boathouse $500 jj <br /> Camping Unit(Six Months/Year) $100 <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 r <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 /> Property Owner's Name: 190( A, Ny fG LA) 1, L /A < <br /> Property Owner's Mailing Address: �07 7 O /� / 1/v/ �✓F $ <br /> City State Zip o <br /> Property Site Address: � f G,Q /Vj �/Q(o4W 619/ :�f !jya <br /> Contact's Telephone Number: 7/5- <br /> '9004PLN <br /> R. <br /> Contact's Email: �' l <br /> Legal Description of Property: AgL <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. <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: Z-7 AA10 Y <br /> Anticipated Start Date: //'/ _ /QV (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ) <br /> Building Contractor: N.l01,eQ MiU/riSewer Installer: <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> � THIS PERMIT sIS�SUBJ�E`C�TcO ALLCONDIIOk�LISTSD PALO <br /> UN <br /> Fee RecD. ,00 <br /> C <br /> Omo <br /> Date of staff site visit:���Q- ' Initials of site visit staff: 5-13Z_ :j `1 <br /> o PERMIT APPROVED BY ZONING OFFICIAL: DATE: ` Z o <br /> Page 1 of 3 <br /> Burnett County,WI Land Use Application—Rev 10/2016 �� <br />