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LAND USE PERMIT APPLICATION-Burnett County, WI W <br /> Applicant Complete All Sections Below This Line e v <br /> Permit Types and Fees:(Check appropriate box/boxes) ° <br /> Dwlling/Princi al Building-Single Family $300 1 jAddition to Dwelling/Principal Building-Single Family $200 g <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 <br /> Commercial/Industrial Building $300 lAddition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) $150 jAddition to Accessory Structure $150 <br /> n � <br /> Bunkhouse r$25O Structural Alteration to Accessory Structure $150 < <br /> Accessory Structure-Commercial(Cl &11) Addition to Accessory Structure-Commercial(Cl &11) $200 t, (J <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 <br /> Campground Structures Filling/Caading 5150 <br /> Camping Unit(Six Months Per Year) Boathouse $500 <br /> m <br /> Permit Extension(Valid for one year-Only 1 Allowed) S <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 diBrent aPPlicationIornt,see corresponding application andIes. <br /> o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> ��,1 /1 �� /'/ ten' <br /> Property Owner's Name: r!(.(Jr 1/T, GLI= C K�K Iu G 77 C D�S[J/l�\ K <br /> V • (,� y <br /> Property Owner's Mailing Address: _ a <br /> �� ,,,,,,, I' y2 City Stat Ztp <br /> Property Site Address: r U Yl!/IY�( �1' (.[MSTZZ a EE <br /> Contact's Telephone Number: IoSl 05�— �/3-ETV <br /> o � <br /> Contact's Email:& rr% <br /> L,bT 05M V t PA-3 U 14 -39-// <br /> Legal Description of Property: � �j�T' Uj <br /> Section#: ?sem Town#:�N Range#: ! _W Town of Ql U� <br /> 1 <br /> *Attach additional page i(needed for lengthy description OR attach apcopy of the deed OR attach tar system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): t�p 607- <br /> Proposed Use of Structure/Ad ition � 7C <br /> Anticipated Start Date: / (HomeiCabin;Commercial Business;Bedroom;Deck;etc.) <br /> n <br /> Building Contractor: Sewer Installer: <br /> w <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CON1DITIONS LISTED <br /> pB OW: « <br /> c-F ,fjc-T� avec}. INnO be ►nO ::� <br /> k�4�T\ Cj / +a O i(�hJ a Fee Recl��o00 <br /> B 1 <br /> Date of staff site visit ' Initials of site visit staff: v <br /> M <br /> PERMIT APPROVED BY ZONING OFFICIAL•�� TE: Z� 7ZI (1F1 <br /> o Q <br /> Page 1 of 3 ; Z <br /> Burnett County,WI Land Use Application—Rev 03/2017 <br /> m <br /> m <br />