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LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line a �R <br /> Permit Types and Fees:(Check appropriate box/boxes) a <br /> d <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 c o <br /> Accessory Structure(Non-Bunkhouse) $150 Bunkhouse $250 ) � <br /> n _ <br /> Addition to Ace.Structure $150 Addition to Accessory Structure-Commercial(Cl &11) $200 <br /> Accessory Structure-Commercial(Cl &11) $200 Gazebo(Wl Stat 59.692(lv)) $350 0 <br /> Deck/StairstPatio/Retaining Wall/Sidewalk/Driveway& Filling/Grading $150 <br /> m <br /> 0 <br /> Campground Screen Porches $125 Boathouse $500 <br /> Camping Unit(Six Months/Year) $100 <br /> v <br /> m <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 r- <br /> o - <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 structures,such as:pergolas,landscaping,etc. <br /> 1 /I� ! z <br /> PropertyOwner's Name: �t-�'/ � Mat'r+r,a/✓I'n+e- .}r'�t,� < y <br /> Property Owner's Mailing Address: o-,5a5 IV lSlle jR�d(,., ,-,,,t /-,-] � a <br /> `t lSl I rah I5 yr U)yy ,(©tate Zip o <br /> Property Site Address: II /� `t o <br /> Contact's Telephone Number: p OL"l' �g N uo <br /> Contact's Email: ro I Iyi a b l ock 45-7 o @ 1�al�ao , co wl 3 c8`89 d , <br /> ,`^^ ► d <br /> Legal Description of Property: 960 <br /> Section#: Town#: N Range#: W Town of: LCt(S a� n <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach agcopy of deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Additi n: C0. rr0. <br /> ( a 'L - tinvc-ttaChM 't-a lied <br /> Anticipated Start Date: AN eL. eza, me/ b{i-n�;Commercial Business;Bedroom;Deck;etc.) <br /> vi <br /> Building Contractor: Mw 5�xnsonem, fn, 'SeweerInstaller- n/a n z <br /> y <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL COONDITIONS LISTED BELOW: <br /> Fee Rec: 15 b <br /> C <br /> Z n �� <br /> Date of staff site visit: -45:= 1 - - 1 6 Intisof site visit staff: S t Mt z <br /> �J w <br /> PERMIT APPROVED BY ZONING OFFICIAL DATE: / 110 o ! <br /> V <br /> Page 1 of 3 Z <br /> Burnett County, WI Land Use Application—Rev 10/2016 �0� <br />