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LAND USE PERMIT APPLICATION—Burnett County, WI r <br /> a s <br /> N <br /> Applicant Complete All Sections Below This Line - n v <br /> 6 f� <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> d <br /> DssellingPrincipal Building-Single Family $300 Addition to DeellingP rincipnl Building-Single Family $200 <br /> Deelling'Pnncipal Building-Multi-Family $300 Addition to DmIlingWincipal Building-Multi-Family $200 p <br /> Commerciaiflndustual Building $300 Addition to Commercial/Industrial Building $200 <br /> I <br /> 5250 <br /> Accessory structure(Non-Bwikhouse) a0 Bunkhmtse 7 <br /> c <br /> Addition to Ace.Structure 5150 Addition to Accessory Structure-Commercial(Cl &ti) S200 �.. <br /> r <br /> Accessory structure-Commercial(CI &11) $200 Gazebo(Wl Stat 59.692(lv)) 5350 0 <br /> Filling/Grading $151) v, <br /> DeckiStairs/PatiolRetaining Wall/SidewalklDrivcway& p E <br /> Campground Screen Porches $125 Boathouse $500 T <br /> Campine Unit(Six Months,Year) $100 <br /> Permit Extension(Valid for one year-Unly l Allowed) $100 <br /> z <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. ,� ) <br /> "C'onimunication Towers&Signs require a different application form.see corresponding application and.fees. Q <br /> 'Items not listed above trill be treated as accessory structures,such as:pergolas,landscaping,etc. c <br /> 7 n <br /> Property Owner's Name: ]1A'-A- dLArli-t-161= K _ Z <br /> Property Owner's Mailing Address: tie tc ' z O <br /> -1 � /�, n City State Zip d <br /> Property Site Address: .--?705 /16ofF5cn RC1 Rik , <br /> Contact's Telephone Number: /-,PPL -pbd -1701 2 r <br /> Contact's Email:T,E}(-y5U Wi Ks-/�1 ,7 'A ow / <br /> Legal Description of Property: q'OU L&k .)+3 6ei'- Fj 7'y0 N �i't(J-tom X-901 o4krlGK:St'%— <br /> Section#: Town#:�_N Range#: /5 W Town of: �Y� SG✓l <br /> *:I ttach additional page if needed for lengthy description OR attach a copy o/the deed OR attach tax system property page.` [� <br /> Tax ID#(l-5 digit number;found on tax statement): <br /> C®83 <br /> Proposed Use of Structure/Addition: e- rt( ^ I <br /> Anticipated Start Date:�1A 1�•�-fL (Honieffabi ;Commercial Business;Bedroom;Deck,etc) <br /> r. <br /> Building Contractor: T Le Omskij rd ti Sewer Installer: <br /> z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Ui <br /> Ft:c ReJSV' <br /> v <br /> H <br /> 0 <br /> T <br /> N <br /> rJ <br /> 2 <br /> n C <br /> Date of staff site visit: J ' Initials of site visit staff: i�q 2 <br /> M <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: GA p-1 <br /> h.r <br /> Page 1 of 3 o O <br /> Burnett County,WI Land Use Application-Rev 02/2017 > Z _ f� <br /> 3 <br /> v <br /> x <br /> A <br /> m <br />