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LAND USE PERMIT APPLICATION— Burnett County, WI a C�1 � <br /> Applicant Complete All Sections Below This Line ' a <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> d <br /> Duelling/Principal Building-Single Family $300 Addition to Duelling/Principal Building-Single Family $200 <br /> Duelling/Principal Building-Multi-Family $300 Addition to Duelling/Principal Building-Multi-Family $200 O <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) $150 Bunkhouse $250 <br /> _ ` Z <br /> Addition to Ace.Structure $150 Addition to Accessory Structure-Commercial(Cl &11) $200 < N <br /> Accessory Structure-Commercial(Cl&11) $200 Gazebo(WI Stat 59.692(l v)) $350 S' G <br /> Deck/Stairs/Patio/Retaining Wall/Sideualk/Driveway& Filling/Grading $150 rn <br /> Campground Screen Porches $125 Boathouse $500 ' <br /> Camping Unit(Six Months/Year) $100 " T <br /> Permit Extension(Valid for one year-Only I Allowed) $100 <br /> Z <br /> *NOTE After-the-fad(when no permit is obtained prior to construction)is up to three times the normal fee. ° <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: Cly,$if d of r r S t f Cf>h Gf ve L N 4 <br /> Property Owner's Mailing Address: ;$SQ9 60C444te , H. C Le/ WX .!ryY73 0 <br /> //f� City State Zip d <br /> Property Site Address: d4syl 1 <br /> Contact's Telephone Number: <br /> - N <br /> Contact's Email: ell kr-(f�'G___ �'l" <br /> Legal Description of Property: oe:* <br /> Section#: / Town#: 'YO N Range#: _W Town of. SGs .� i <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 /> Q 1 <br /> Tax ID#(1-5 digit number;found on tax statement): /y Q I 0) <br /> Proposed Use of Structure/Addition: S�0/DI' T V' 0 <br /> Anticipated Start Date: (/come/ abin;Commercial Business;Bedroom;Deck;etc.) + p{ <br /> Building Contractor: ��T Sewer Installer: n z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> ' t Fee Rec: 5 0 <br /> W <br /> N m o <br /> Date of staff site visit: I I -( � Ini ials of siteisit staff: S <br /> Z� c <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: — �G G)C c <br /> Page 1 of 3 Z <br /> Burnett County,WI Land Use Application—Rev 10/2016 .4 �� <br />