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t� <br /> LAND USE PERMIT APPLICATION - Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Check appropriate box/boxes) <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 Addition to Commercial/Industrial Building $200 , <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 X! <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 0+ <br /> 1 S <br /> Accessory Structure-Commercial(CI&11) x;200 Addition to Accessory Structure-Commercial(CI&Il) $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 <br /> Campground Structures $125 1 Filling/Grading $150 <br /> Camping Unit(Six Months Per Year) $100 1 Boathouse $500 <br /> m <br /> Permit Extension(Valid for one year-Only 1 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. o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. <br /> 7 !7 <br /> Property Owner's Name: Ql`ro Wr%-4 Lv L'P P, <br /> Property Owner's Mailing Address:C W5 M A �14 S;" (� va k 0i). �3 a <br /> Cily State Zip G <br /> Property Site Address: <br /> Contact's Telephone Number: <br /> �/� w <br /> Contact's Email: e�1N1 ar�cu ((��! )'O• o At) p i <br /> Legal Description of Property: L-4 y> CS t 1' Q J �� 111A, <br /> � <br /> Section#: Town#: N Range#: W Town of: O FI f"-A y t <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page.* N a <br /> Tax ID#(1-5 digit number; found on tax statement): <br /> Proposed Use of Structure/Addition: C A <br /> Anticipated Start Date: / (Home/Cabin;tojAmercial Business;Bedroom;Deck,etc.) <br /> Building Contractor: CAAPI O t(W q L71i 1`AQe '. Sewer Installer. <br /> � z <br /> z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THISPERMITIS SUBJECT TO ALL <br /> /CONDITIONS LISTED BELOW: <br /> A// r S;�e 1/ts.`� <br /> �- Fee Rec: /S0- <br /> H <br /> S <br /> w <br /> d <br /> m <br /> z C <br /> n Z <br /> Date of staff site visit: J 7 Ini al of sr% <br /> ite ' It staff: - m <br /> J --�il � ;('lf <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: - )9` )-7 O N <br /> m o <br /> Page 1 of3 0 �� <br /> Burnett County,WI Land Use Application—Rev 03/2/2017 � C7 <br /> b <br /> x <br /> m <br /> A <br /> m <br />