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LAND USE PERMIT APPLICATION— Burnett County, WI a C,- <br /> Applicant <br /> A licant Com lete All Sections Below This Line ? - <br /> i <br /> Permit Types and Fees:(Check appropriate box/boxes) — <br /> V U'� <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family 5200 <br /> Dwellin&'Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family 5200 'C <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building 5200 <br /> Accessory Structure(Non-Bunkhouse) 5150 Bunkhouse 5250 <br /> c <br /> Addition to Ace.Structure 5150 Addition to Accessory Structure-Commercial(Cl &Il) 52011 �- <br /> I <br /> Accessory Structure-Commercial(Cl &Ill 5200 Gazebo(Wl Stat 59.692(lv)) 5350 0 <br /> Deck.!Stairs/Patio/Retaining Wall/gdewalk/Driveway& Filline,/Caading 5150 <br /> Campground Screen Porches 5125 Boathouse 5500 ' <br /> Camping Unit(Six Months/Year) 5100 Q'nd Ure� �-eN Pty <br /> c <br /> Permit h:xtension(Valid for one year-Only I Allowed) 5100 t" <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. <br /> `Communication Towers&Signs require u dr/ferenl applicatior loan,s,e corresponding application <br /> *hrems not listed above will be treated as accessory structures,such as:pergolus,landscaping,etc. y <br /> /� j J r ' <br /> Property Owner's Name: Of /'t o L s t1 V i 1 if K 4 z <br /> Q — <br /> +, o O <br /> Property Owner's Mailing Address: �� �� �� / v <br /> �y / City State Zip <br /> Property Site Address: �! ©� R �� y C�L �✓ �i V e R� ^a <br /> 1 — S ,Z `( S C <br /> Contact's Telephone Number: X67 33PQ ° <br /> �t N <br /> I <br /> Contact's Email: cy U—f h 17 Q �� <br /> Legal Description of Property: <br /> Section#: Town#: N Range#: W Town of: G 1 ¢ C _ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax sustem property page. <br /> I <br /> Tax ID#(1-5 digit number;found on tax statement): 3 q 6� <br /> Proposed Use of Structure/Addition: C Q n, I-, r1 <br /> Anticipated Start Date: (Home/Cabin:Commercial Business:Bedroom Deck.etc) r- <br /> Building Contractor: > C t I Sewer Installer: <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY � q <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELONV C7 <br /> • �o I I�w rte( (xy-AAtors on <br /> Fee Rcc: )V(D <br /> �CVfl %x) <br /> Date of staff site visit:_ Initials of site visit staff: _ Z M <br /> I—ate _.d <br /> toU <br /> PERMIT APPROVED BY ZONING OFFICIAL llADATE: 17 a)O o <br /> Page 1 of 3 Z �V <br /> Burnett County, WI Land Use Application—Rev 1/2017 fir—= <br />