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LAND USE PERMIT APPLICATION— Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line ' <br /> Permit Types and Fees:(Check appropriate box/boxes) e a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwel]ing/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 I O <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> t7 <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 < <br /> Accessory Structure-Commercial(CI&Il) $200 Addition to Accessory Structure-Commercial(Cl &Il) $200 0 <br /> Deck/StairstPatio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 E <br /> Campground Structures 5125 Filling/Grading $150 .. <br /> iv <br /> Camping Unit(Six Months Per Year) $100 11 Boathouse $500 <br /> ro <br /> Permit Extension(Valid for one year-Only 1 Allowed)1$100 <br /> 0 <br /> Z <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. p <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. c <br /> *Items not listed above will be treated as accessory structures,such as:per alas,landscaping,etc. °ori <br /> Property Owner's Name:a,`s 4 A h SQ Te 4e/Son <br /> ., <br /> 1,o O y <br /> Property Owner's Mailing Address: 45 'e T C,rs /'� a t <br /> Property Site Address: 9101{5 ?e ' aal �d & Cr W& d <br /> Contact's Telephone Number: 71 S- 3Y 5q9- 0,:253 N ro <br /> Contact's Email: 9 <br /> a ad <br /> Wl *� 00 <br /> Legal Description of Property:5 Se FX /p t 3. <br /> Section#: Town#: N Range#: W Town of:�n/(� S , � <br /> Uj <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> Tax ID#(1-5 digit number;found on tax statement): JOW <br /> Proposed Use of Structure/Addition: 44— <br /> Anticipated Start Date:,JtuAgV Q-AlT,�[7__l7LL (Home/Cabin;Commercial Business;Bedroom;Deck,etc.) X <br /> Building Contractor:?e7>°�S LllY1X/1TM Sewer Installer: JN <br /> N <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Fee R4 <br /> 6 <br /> m <br /> N <br /> O <br /> Z � <br /> '1- aS- 17 c <br /> Date of staff site visit: Initials of si visit staff.� z N Z P;l'1l <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE — vl j t-Z r <br /> n O <br /> Page 1 of 3 0 <br /> Burnett County,WI Land Use Application—Rev 03/2017 a, <br /> b <br /> M <br /> m <br />