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to <br /> _ LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line �! <br /> 6t <br /> Permit Types and Fees:(Check appropriate box/bores) � O <br /> d <br /> Dwelling/Principal Buulding-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 01 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principai Building-Multi-Family $200 v O <br /> Commercial/Industrial Building Addition to Commercial/Industrial Building $200 1 <br /> Accessory Structure(Non-Bunkhouse) 50 Bunkhouse $250 <br /> P <br /> Addition to Ace.Structure $150 Addition to Accessory Structure-Commercial(Cl &11) $200 <br /> Accessory Structure-Commercial(Cl &11) $200 Gazebo(WI Stat 59.692(lv)) $350 <br /> Deck/Stairs/Patio/Retaining WaWSidewalk/Driveway& Filling/Grading $150 w <br /> Campground Screen Porches $125 Boathouse $500 <br /> m <br /> Camping Unit(Six Months/Year) $100 <br /> m <br /> Permit Extension(Valid for one year-Only 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 /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Owner's Name: 0 b ` U -e— <br /> Property 3 'z <br /> Property Owner's Mailing Address: o no <br /> 1 ` i City l Statue 1 Zip p <br /> Property Site Address: y ' ,�n(Cid j \l�Q - 1/� �!c.�t►stotl i`� to l i , <br /> � 5 — /SSS �� ;21 «I1 5oI - <br /> Contact's Telephone Number- 0(006 <br /> Contact's Email: A Cl- ` �'� 06 �/ a�� 1 \ t 6ff a: -, � 1 <br /> v <br /> Legal Description of Property: 5. <br /> Section#: Town#: N Range#: W Town of: tjrA&C:41 &K N <br /> 20 <br /> 1 <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digit number;found on tax statement): I <br /> i AS <br /> Proposed Use of Structure/ dditio C — a-r-M U 1 <br /> Anticipated Start Date: jj t/ l ome/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> ' Il � x <br /> Building Contractor: � 0 h 5 O Sewer Installer: Z <br /> W <br /> N X <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMrrIT S SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Fee Rec: 1.50 <br /> W <br /> C <br /> M0 <br /> � M � <br /> Date of staff site visit: A)'30 Ini 'als of site vi ' staff: Z <br /> /J N <br /> PERMIT APPROVED BY ZONING OFFICIAL: u.C.l DATE: 36 -/to G0C) <br /> Page 1 of 3 z <br /> Burnett County,WI Land Use Application—Rev 10/2016 :� `�/ <br />