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r <br /> LAND USE PERMIT APPLICATION — Burnett County, WI70 <br /> a <br /> y. <br /> Applicant Complete All Sections Below This Line $ i <br /> Permit Types and Fees:(Check appropriate box/boxes) ° <br /> Dwelling/Principal Building-Single Family $300 Addition to Dvelling/Principal Building-Single Family $200 �^ <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 ) - <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 17, ~ <br /> G1 0 , <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 _ <br /> Accessory Structure-Commercial(Cl&11) $200 Addition to Accessory Structure-Commercial(Cl&11) $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(l v)) $350 w <br /> Campground Structures $125 Filling/Grading $150 <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 �.o <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 r. <br /> o <br /> z <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. o <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. -71 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping, <br /> etc. ` a0. <br /> Property Owner's Name: n e.( (' n L.UI"G rC� U �GL o K <br /> / z <br /> 1 C y <br /> Property Owner's Mailing Address: !o �/'7 e, <br /> State a t.(o g�0 /e./SL'/7LosC1 u� �S LLPr gy tear Zip o <br /> Property Site Address: <br /> of <br /> c� <br /> Contact's Telephone Number: — �Q �v7,�-;2 0 <br /> Contact's Email: B7s"r� N 5�0 <br /> W 0'7 ,I <br /> Legal Description of Property: PCL SW SW Com SW CO-k1T1'I _/I'TN G 5& <br /> Section#:_ I Town#: ? N Range#: 1 —] W Town of: LI r l SDI (1 70 toOt9 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* I F <br /> Tax ID#(1-5 digit number;found on tax statement): 3 CO J a <br /> - <br /> Proposed Use of Structure/Addition: Ada '" +�O1� -t� j <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) x <br /> rn � <br /> n <br /> Building Contractor: Sewer Installer: z <br /> m <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW' <br /> J � <br /> Fee Recaao <br /> x <br /> 0 <br /> m <br /> N <br /> O <br /> n C <br /> �I y Z c <br /> Date of staff site visit: 6 —�� 1 J Initials of site visit staff: � � �� z <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: ) O c <br /> 75- <br /> v Y u r+ <br /> Page 1 of 3 c Z <br /> Burnett County,WI Land Use Application-Rev 03/2017 > C� <br /> b <br /> x <br /> M <br /> A <br /> M <br />