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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Check appropriate box/boxes) a 't <br /> Dwelling/Principal Building-Single Family $300 1 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 11 Structural Alteration to Dwelling/Principal Buildings $200 I _ <br /> Commercial/Industrial Building $300 11 Addition to Commercial/Industrial Building $200 <br /> J� <br /> Accessory Strutc[ure(Non-Bunkhouse) $150 1 Addition to Accessory Structure $lgp � 1 <br /> Bunkhouse $250 Structural Alteration to Accessory Strtntire $150 <br /> Accessory Structure-Commercial(CI &11) $200 Addition to Accessory Structure-Commercial(CI& 11) $200 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 y <br /> Campground Structures $125 Filling/Grading $150 <br /> m <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 <br /> b <br /> Permit Extension(Valid for one year-Only I Allowed) $100 S, ^ <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. F <br /> 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. °o0 <br /> �• n <br /> Property Owner's Name:��/QtLc �S 9t- C/ -7z>WeLE y z <br /> O_ y <br /> Property Owner's Mailing Address: 8 Z (? ,[, <br /> City State Zip a <br /> Property Site Address: /0,2 -7A) ' •1C',r AK ARZ SPco+UE w/Se 54/7.0/ g <br /> Contact's Telephone Number: lv.S/- 5/P9- %e �o o <br /> 0 <br /> 5' <br /> Contact's Email: o <br /> Legal Description of Property: pir Tw:� p,r- Ill w 14 o,s y� 0' <br /> Section#: Town#:RjJS/ N Range#: W Town of: OS-/< a ) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* t f t <br /> Tax ID#(1-5 digit number; found on tax statement): ,1 <br /> Proposed Use of Structure/Addition: 5"7-p,_A G !ShtOd r a 1(2 <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) F <br /> rn <br /> Building Contractor: Sewer Installer: y z <br /> m <br /> a <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: <br /> fn <br /> h <br /> d <br /> M <br /> N <br /> n � <br /> z <br /> Date of staff site visit: In* ials of sit t ff / ' ON z <br /> z z � U ut# <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: Z 7r � <br /> Page 2 <br /> 03 0 <br /> Burnett County,WI Land Use Application—Rev 03//2017 <br /> 3 <br /> v <br /> s <br /> m <br /> A <br /> m <br />