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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> s. 'b <br /> Applicant Complete All Sections Below This Line <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-Mufti-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 0 <br /> Accessory Structure(Non-Bunkhouse) $150 Bunkhouse $250 <br /> Addition to Acc.Structure $150 Addition to Accessory Structure-Commercial(Cl&11) $200 d; <br /> Accessory Structure-Commercial(Cl&11) $200 Gazebo(WI Stat 59.692(lv)) $350 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Filling/Grading $150 r n " <br /> Campground Screen Porches $125 Boathouse $500 t" <br /> Camping Unit(Sot Months/Year) $100 <br /> Permit Extension(Valid for one year-Only 1 Allowed) 5100 <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. Q' <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,lands�xpinjz,etc. 295 <br /> a• n <br /> Property Owner's Name: Pat(i C i a k r,h 0. z <br /> Property Owner's Mailing Address: 26,4(4 L1 I 01h u;Sk Me, mkvmeapoits Mw 55 y l(o g <br /> City State Zip d <br /> Property Site Address: )-S(A3 bridge ad . yAylbury � Wf 54830 Rat <br /> Contact's Telephone Number: to 1a) 9(v l - X6 i U ro <br /> i <br /> Contact's Email: 10k �� l eD V� -t�S�a \_V -Y-a_ <br /> Legal Description of Properry:f <br /> GSm 4131�1 VA l Z �}013 4 w; W- I <br /> Section#:3_Town#: `7(rJ N Range#: %5- W Town of SfmIAr4 rn y I <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage.* ' <br /> I � <br /> Tax ID#(1-5 digit number;found on tax statement): Jr14� <br /> Proposed Use of Structure/Addition: u ry H <br /> Anticipated Start Date: -'g--/e' go <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor. V �UN 3�y Sewer Installer: La„ y z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTSICONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> /V\v �- <br /> �G`nG.e <br /> \ O I Fee Rec.. co <br /> L 2i <br /> ` o <br /> 0 <br /> Date of staff site visit: � � Initials of site visit staff: � C <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE:— �— I 1Z <br /> 1 � <br /> Page 1 of 3 N <br /> 0 <br /> Burnett County, WI Land Use Application—Rev 02/2017 Z <br />