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LAND USE PERMIT APPLICATION—Burnett County, WI C r <br /> Applicant Complete All Sections Below This Line a <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> D%elling/Principal Building-Single Family $300 11 Addition to Dwelling/Principal Building-Single Famih $200 <br /> Dwelbng/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings 5200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building 5200 ) <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 <br /> Accessory Structure-Commercial(CI&U) $200 Addition to Accessory Structure-Commercial(Cl&11) $200 i~ <br /> Deck/Sta rs(Patio/Maining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 <br /> CampgroundStnxtures $125 Filling/Grading $150 ��• <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 �.o <br /> 0 <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 <br /> z <br /> *NOTE:After-the-fad(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. <br /> 0 <br /> *Items not listed above will be treated/as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: tly,S Lt"ta9� R. nik:m LC 7ikgz <br /> Property Owner's Mailing Address: f{ a <br /> r-�,�� City State ip o <br /> Property Site Address: 2?5V2 rr 0M1?Xri L06 RS'7 Qq <br /> Contact's Telephone Number: Z - d©( 5 ✓T v,"3 N 1 V <br /> �kl P n'T' L • <br /> Contact's Email: w n t7 <br /> Legal Description of Property: ��Ci 1 J'�'�1]�� 3• <br /> Section#: Town#: N Range#: W Town of: o' <br /> H <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number;found on tax statement): H <br /> Proposed Use of Structure/Additi n: i4 fZ gjFlam! <br /> Anticipated Start Date: _ol 7 (Home/Cabirt;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: L Sewer Installer: 1 dr1/A n <br /> � z <br /> z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C:� <br /> (� 5 Fee Rec:/_LV,t.0 <br /> u, <br /> CtCA <br /> V <br /> M =Dsz) <br /> O <br /> z <br /> Date of staff site visit: / initial f site vis' <, � 3 / NAM <br /> l7I <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: Z.Q N r= <br /> O <br /> Page 1 of 3 <br /> Burnett County,WI Land Use Application—Rev 03/2017 <br />