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LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> a y C <br /> Applicant Complete All Sections Below This Line J <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> 0 <br /> Dwelling/Principal Building-Single Family $300 11 Addition to Dwelling/Principal Building-Single Family $200 co <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 0 <br /> F <br /> Commercial/Industrial Building $300 Addition to CommerciaUlndustrial Building $200 1 � <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> n 1 <br /> 0 <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 <. <br /> Accessory Structure-Commercial(Cl &11) $200 Addition to Accessory Structure-Commercial(Cl &I I) $200 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Crazebo(WI Stat 59.692(lv)) $350 r <br /> Campground Structures $125 Filling/Grading $150 �• <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 <br /> 'v <br /> ro <br /> Permit Extension(Valid for one year-Only I Allowed) $100 r- <br /> o <br /> z9^ <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. vl <br /> *Communication Towers&Signs require a different a lication orm,see corresponding application and ees. <br /> g 9PP f Pon g PP f '� <br /> *items not listed above will be treated as accessorystructures,such as:pergolas,landscaping,etc. 9 <br /> Ryah TIM ff KW -� <br /> Property Owner's Name: c� z <br /> (�� ^� a <br /> Property Owner's Mailing Address: SIO J U m eY r• JU Q 1 54�/✓ q( <br /> a 7 City State Zip v <br /> Property Site Address: I 0 / N. M ud H e►, Lake, Dv - d <br /> Contact's Telephone Number: lIC 5 I - 4`11 - 1 1 I `T' w d 1 <br /> t <br /> Contact's Email: ry61hhG1dcv qha� 1Nn n^1 ,V l °O 1 <br /> /� <br /> 1 ,{ a <br /> Legal Description of Property: S e t Q 7 QcI ed � <br /> 1 <br /> Section#: Town#: N Range#: W Town of: � Irl <br /> *Attach additional page if needed for lengthy description OR attach a copy of the <br /> deed OR attach tax system propertypage.* 1 <br /> Tax ID#(1-5 digit number;found on tax statement): ZI 1 2 I 18 <br /> Proposed Use of Structure/Addition:r(,& h <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck:etc.) Q <br /> t A (7 <br /> Building Contractor: S7 BVL Ye.7—cy Sewer Installer: A Ireadv [ z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CON ITIONS ONLY L <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 1I�Ir <br /> L \� —7 Fee Rec:3�rC� <br /> v / s <br /> Vf <br /> v <br /> m <br /> N <br /> O <br /> z (� ✓V <br /> z <br /> Date of staff site visit: <[� �+S- 1 Initials of site visit staff: <br /> r Om <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: <br /> _ s t co 0 <br /> Page 1 of 3 Z <br /> Burnett County, WI Land Use Application—Rev 03/2017 z <br /> M <br /> A <br /> m <br />