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LAND USE PERMIT APPLICATION—Burnett County, WI °i g <br /> Applicant Complete All Sections Below This Line ' 1 <br /> Permit Types and Fees:(Check appropriate box/boxes) le <br /> DNelling/Principal Building-Single Family $300 Addition to 13 elling/Principal Building-Single Family $200 , <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 �/(�J O <br /> CommerciaVlndustrial Building $300 Addition to Commercial�Industrial BWlding 5200 \ 1 1 <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure SI50 <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $I50 <br /> Accessory Structure-Commercial(Cl&11) $200 Addition to Accessory Structure-Commercial(Cl&II) $200 1 0 <br /> Deck/Stairs/Patio/Retaining WaWSidewalk;Driveway& Gazebo(Wl Stat 59.692(l v)) S350 w <br /> Campground Structures $125 Filling/Grading 5150 <br /> Camping Unit(Six Months Per Year) $100 113oathouse $500 <br /> ro <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 r. <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. 9 <br /> *Communication Towers&Signs require a different applicadonform,see corresponding application andfees. <br /> g <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landsca in ,etc. <br /> � 5' y <br /> Property Owner's Name: U 2 A �� —1 \C 4 IA'n1 C o <br /> < Z <br /> n \' a <br /> Property Owner's Mailing Address: z 3 �T� l 2\ bu w c <br /> City State Zip o t <br /> Property Site Address:2�AMS GAL-?S104 <br /> Contact's Telephone Number: 9S2 ZSa DLOO(, b <br /> Contact's Email: LI 'a-be k . f ©y f S (�&Oy O,MA t 1 L,pj YY\ Q <br /> E' <br /> 5. I <br /> Legal Description of Property: I 1 <br /> Section#:�S 3 Town#: N Range#:� W Town of: W D ST M415h lt:fl� rt"t1111 <br /> IW o I <br /> *Attach additional page ijneeded for lengthy description OR attach a copy of the deed OR attach tax system proper(v page.* ( <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: A <br /> Anticipated Start Date:':S�u ?-Oil (Home/Cahin,Commercial Business:Bedroom;Deck;etc.) <br /> Building Contractor: &Conow.y G A fLA.CI. Sewer Installer: y z I <br /> m <br /> A <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Fee Rec: <br /> H <br /> S <br /> N <br /> N_ <br /> m <br /> O <br /> Z <br /> Date of staff site visit: Ini ials of site visit staff: Z D <br /> PERMIT APPROVED BY ZONING OFFICIAL -9DATE: n Z <br /> Page 1 of 3 0 V <br /> Burnett County,WI Land Use Application—Rev 03/2017 > <br /> m <br /> A <br /> m <br />