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LAND USE PERMIT APPLICATION —Burnett County, WI G r <br /> y' ty 1 <br /> Applicant Complete All Sections Below This Line 0' y ~ <br /> J <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> d <br /> Dwelling/Principal Building-Single Family $300 Addition to DwElling/Principal Building-Single Family $200 0 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dcctlling/Principal Building-Multi-Family $200 ^ <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 ` o <br /> Accessory Structure(Nan-Bunkhouse) $150 X Bunkhouse $250 <br /> Addition to Ace.Structure $150 Addition to Accessory Structure-Commercial(C] &I1) $200 <br /> Accessory Structure-Commercial(Cl &11) $200 Gazebo(WI Stat 59.692(lv)) $350 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Filling/Grading $150 rn <br /> Campground Screen Porches $125 Boathouse $500 ' <br /> Camping Unit(Six Months/Year) $100 <br /> rn <br /> R <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 � 3, <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 /> Property Owner's Name: C Or11� �'qu(,S$1 Cal ]A(.kSoy% 4 <br /> Property Owner's Mailing Address: VV'K IA a <br /> " City State Zip C7 <br /> Property Site Address: 301 a� JOhvs ova L.ak c AVL l,>6Lnb1*mt VVI_ 5S$jj�a <br /> Contact's Telephone Number: ,15— JTU0_011I1P N 1b-51!tp-0X1P3 N ° <br /> Contact's Email: Com ip 'uQ(,kS6y-,_%AYj_ ,. [_ <br /> Legal Description of Property: L4 5 G5 r" V 18 p 4 7 i►-3 H 14 oS CC-it d LOT X ��F Be j9a s. <br /> Section#: Town#: N Range#: W Town of: 5 vNIS S <br /> o <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: C11Lep,gt-- � St- <br /> Anticipated Start Date: k4-1-1-7 If (home/Cabin;Commercial Business;Bedroom;Deck;etc.) C" <br /> Building Contractor: �Ll(.{(�Cw���lA�v�• Sewer Installer: ,,�"" d4s^ ?kA4j Lil.4 z �1 <br /> z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS ERCT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: (� <br /> -- e e r1C e O r o Q S c9 CbJ n& Fee Rec:GYM e <br /> �ryo y�f c{ S i e, o�' �L't1. II ' p cry V(,_- �'/e_�r'tri <br /> I •r{ 1.51/1 L_ SSI JL-- Si�r[ KAU� /\S Y1 c_ <br /> Z m S� <br /> M <br /> Date of staff site visit: o�_ w — Initials of site visit staff- --S 1 1 <br /> 0 s� <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: E <br /> C o <br /> Z flf <br /> Page 1 /2 3 ��--� <br /> Burnett County,WI Land Use Application—Rev 1/2017 �� <br />