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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line 0' <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> d <br /> Dwelling Principal Building-Single Family $300 Addition to Dvclling/Principal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 <br /> I <br /> Commercial/Industrial Building $300 Addition to Commercial/industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) G?Q%► 2 $150 Addition to Accessory Structure $150 I <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 °< <br /> Accessory Structure-Commercial(Cl &11) $200 Addition to Accessory Structure-Commercial(Cl&11) $200 c <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(W1 Stat 59.692(lv)) $350 cr <br /> Campground Structures $125 1 Filling/Grading $150 <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 <br /> Permit Extension(Valid for one year-Only 1 Allowed) <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 di erent aplicationrorm,see corresponding application andfees. 17 <br /> *Items not listed above will be treated as accessory stnictures,such as:pergolas,landscaping,etc. o <br /> iv n <br /> Property Owner's Name: 1 n,C-LA.04. 3 (�dk"yW4 z <br /> _ 1t nn <br /> Property Owner's Mailing Address: S2 Q/ t; � P+ Pd 6 <br /> 6 <br /> City State Zi ^p <br /> Property Site Address: SAM-t W-f b4en Wr 94 3 1 I <br /> Contact's Telephone Number: 7/5- T-tq ",1,5,-Lv,?3 b <br /> w <br /> AI <br /> Contact's Email: Rs PZ Qow (5 (� t' 4,,PL v Cv M v <br /> Legal Description of Property: (ACL XW 60V 4 dr 5 (LyT e) (5 /z Lyt7) <br /> Section#: Town#: N Range#: W Town of: AA,VcA%4'H e <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* I <br /> Tax ID#(1-5 digit number;found on tax statement): ?370 x(37 ( 0 14) <br /> Proposed Use of Structure/Addition: G 4*-",f (.Zt fJ /Jt Py►t,.c f $�CNI ti'1 ?rN-gs-0 IVi1 �y <br /> Anticipated Start Date: $���/ 2(/I 7 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: S-KUCTtkRAL QQ 11.0 t tv6 .QA64 4Y\J <br /> /t*cSewer Installerc y z <br /> H <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> �D 1 Fee Rec: � <br /> OY� 1\ I O 1 \IVt�� C�Udr JcYS �l IOWeC�_ <br /> J v o <br /> Date of staff site visit: Initials of site.visit staff: ! r�jy <br /> �7 1 <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE <br /> N <br /> o <br /> Page 1 of3 c <br /> Burnett County,WI Land Use Application — Rev 03/2/2017 � Q <br /> 3 <br /> 9 <br /> m <br /> A <br /> m <br />