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r <br /> COD <br /> LAND USE PERMIT APPLICATION —Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line v <br /> Permit Types and Fees:(Check appropriate box/boxes) a <br /> d <br /> Dwelling/Principal Building-Single Family $300 1 jAddition to Dwelling/Principal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to DwellingTrincipal Buildings $200 O <br /> Commercial/industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> 0 <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 <, <br /> Accessory Structure-Commercial(Cl&11) $200 Addition to Accessory Structure-Commercial(CI &11) $200 0 <br /> Gazebo(WI Stat 59.692(lv)) $350 w <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& � <br /> Campground Structures $125 Filling/Grading $150 w' <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 0 <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 aPPlicationform,see corresponding application and ees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> m n <br /> Property Owner's Name:�� �'�5' J �G'i�i!ll�.-✓ z <br /> Property Owner's Mailing Address: J'J ,?/' . '�/l-'/� �✓� >y�'�I a <br /> City State Zip o <br /> Property Site Address: 11-5:;14Y/7'7 Z <br /> Contact's Telephone Number: 7/j' 'G+��v ��Y'7 GG'<G s//���J� 0 M 1 <br /> a <br /> Contact's Email: T g <br /> Legal Description of Property: li Ck,- 4 a,,7- +z <br /> Section#:ScZaZ Town#: 63J,y N Range#: !§l Z./ W Town of: �l�S� 4 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page. <br /> Tax ID#(1-5 digit number;found on tax statement): lg!:�C77Z, <br /> Proposed Use of Structure/Addition: 4;�GC - .,,i! reap r (� <br /> Anticipated Start Date: d- / -17 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> n74z 1 <br /> Building Contractor:A Sewer Installer: z d <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Fee Rec: <br /> y <br /> 6 <br /> m <br /> JS `d <br /> Date of staff site visit: Initials of site visit staff: Z M c <br /> 171 :z: <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: <br /> O <br /> Page 1 of 3 o Z <br /> Burnett County,WI Land Use Application—Rev 03/2017 <br /> o <br /> x <br /> m <br /> x <br /> m <br />