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LAND USE PERMIT APPLICATION—Burnett County. WI s b <br /> Applicant Complete All Sections Below This Line v <br /> Permit Types and Fees;(Check appropriate box boxes) a <br /> Dwelling/Principal Building-Single Family S300 I Addition to Dwelling/Principal Building-Single Family $200 _o, <br /> Dwelling/Principal Building-Multi-Family $300 1 Structural Alteration to Dvtelling/Principal Buildings $200 <br /> CommerciaUlndastrial Building $300 1 Addition to Commercial/Industrial Building $200 � <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 4/ <br /> 1 { <br /> Btmkhouse 5250 Structural Alteration to Accessory Structure $150 <. <br /> Accessory Structure-Commercial(Cl &Il) $200 1 Addition to Accessory Structure-Commercial(Cl&Il) $200 0 <br /> X Deck/Stans/Patio/Retaining Wa0/Sidewalk/Driveway& Gazebo(WI Star 59.692(Iv)) 5350 <br /> Campground Structures $ <br /> 125 Filling/Grading 5150 ' <br /> Camping Unit(Six Months Per Year) 100 Boathouse $500 ,a <br /> Permit Extension(Vaftd for one yew-Only 1 Allowed) 100S' . <br /> z <br /> *NOTE:After-the-fact(when no permit is obtained prior to constmction)is up to three rimes the normal fee. (� ° <br /> 'Communication Towers&Signs require a different application form,see corresponding application and fees. q^ �•J' <br /> "Items not listed above will be treated as accessory structures,such as: ol=,landscaping,etc. e <br /> � <br /> t< <br /> Property Owner's Name: J 14M E S � <br /> L <br /> Property Owner's Mailing Address: kOo\t t LL <br /> Property Site Address: 214&2i&2 V1,W6P AKE ttG J�$/JStak Zip <br /> �i 6Y X,5 <br /> t <br /> Contact's Telephone Number: 4P6'1 ��j _ 910.342 ro t <br /> `' � <br /> 5' <br /> Contact's Email: 1 r+1 kC'VNG 42y'�Q ,1 . Clem— d � <br /> m <br /> Legal Description of Property: ,Plo NN CaR LR 1St E Lm-2 CSM 413 P 145 CPRtT LVI—24 3) l <br /> Section#: Town#: N Range#: W Town of: �p <br /> `n <br /> 0 <br /> *Attack additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.` l <br /> Tax ID#(1-5 digit number;found on tax statement): 4.I TR &II aL) <br /> Proposed Use of Structure/Addition: S TO k 44 t✓ 4P—C— <br /> Anticipated Start Date: IVA)l .31 40/-jl� (Home/Cabin;Commercial Business,,Bedroom;Deck;etc.) ' <br /> Building Contractor: .TONN LJ6A 0 E)- Sewer Installer: �f 19 z <br /> 7y <br /> AREA BELOW TELLS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW:T <br /> 0 W Fee Rec: las <br /> W <br /> H <br /> 4 Z { <br /> Date of staff site visit: 11tials of site sit staff- 1 J > M �PERMIT APPROVED BY ZONING OFFICIALDATE: <br /> Page 1 of3 <br /> Burnett County,WI Land Use Application—Rev 03/2/2017 <br />