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LAND USE PERMIT APPLICATION - Burnett County, WI a _ b <br /> Applicant Complete All Sections Below This Line <br /> a <br /> Permit Types and Fees:(Check appropriate box/boxes) izz <br /> Dwelling/Principal Building-Single Family $300 11 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwelling'Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 O <br /> Commercial/Industrial Building $300 1 Addition to Commercial/industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> G1 <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 _ <br /> Accessory Structure-Commercial(Cl &11) $200 Addition to Accessory Structure-Commercial(C1&11) $200 0 <br /> Deck/StairstPatio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 w <br /> Campground Structures $125 Fdling/Grading $150 '— V 1 <br /> w <br /> Camping Unit(Six Months Per Year) $100 11 Boathouse $500 �-a <br /> Permit Extension(Valid for one year-Only I 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. P <br /> m <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. °o <br /> *Items not listed above will be treated as accessary structures,such as:pergolas, landscaping,etc. o <br /> Property Owner's Name: w 1 l 1 I G1.W) S-t CC r S z <br /> p A �p y <br /> Property Owner's Mailing Address: a O t�Q �� W e JS v O_ �a 13 a t <br /> CState Zip <br /> Property Site Address: U-7 0. Q1d/ 40 <br /> �c t`�2 f., <br /> Contact's Telephone Number: d; <br /> Contact's Email: Ct l I1 a t.Lr S to `is C"' QM 0.1 L'p YY1 0 <br /> Legal Description of Property:Le)"i 'r,7 C s ' 1 i* too aZ Y5 �[ <br /> t <br /> Section#: 35 Town#: < ( N Range#:___ 1_�_W Town of: <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 1 <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Ad [tion: cOl t/I�bt✓�< �' <br /> Anticipated Start Date: ( /a^^Q(1'� ome bin,,Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: y z <br /> 7� <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: AWsM <br /> l 1 <br /> �-c Cs a 1 5` X m�Y,T�s o _p <br /> Z ' <br /> ^� r <br /> Date of staff site visit: �_ �"� � Initials of site visit staff: s M <br /> Ir <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: — -S r� O o <br /> n Z <br /> Pagel of 3 <br /> Burnett County, WI Land Use Application—Rev 03/2017 <br /> x <br /> m <br /> m <br />