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LAND USE PERMIT APPLICATION- Burnett County. WI ro r <br /> < � b <br /> A hcant Com Tete All Sections Below This Line " ¢ �. <br /> Permit Types and Fees:(Check appropriate box/boxes) o° <br /> Daolling'Principal Building-Single Family $300 <br /> Addition to DmellingPrinctpal Building-Sngle Family $200 <br /> Dwelling�Principal Building-Multi-Family � <br /> 5300 structural Alteration to Duelling/Principal Buildings 5200 <br /> Com mercialiIndustrial Building 5300 Addition to Com mercial/In dust rial Building 5200 <br /> Accessory Structure(Noo-Bunkhouse) $ISO <br /> Addition to Accessory stmctare $150 - \ <br /> Bunkhouse $250 <br /> Structural Alteration to Accessory structure 5150 °< <br /> Accessory Structure-Commercial(Cl &11) $200 Addition to Accessory Stmeture-Commercial(CI &Il) <br /> $200 r' <br /> Deck/Stairs/Patio,Retain ing Wall/Sidewalk/Driveway& Cmzehco(WI Stat 59.692(lvp 5330 <br /> Campground Structures 5125 Filling/Grading Camping Unit(Six Months Per Year) 5150 <br /> $100 Boathouse <br /> Permit Extension(Valid for one year-only I Allowed $500) S100 'rU <br /> o <br /> *NOTE:Aftemitte fact(when no permit is obtained prior to construction)is up to three times the normal fee. <br /> *Communication Towers&Signs require a difererrt applimnan form,see corresponding apphmtion and fees. <br /> wdl be treated as acceso I J <br /> *Items not listed above s structures,such as: er oias,iandsm in ,eta o° <br /> Property Owner's Name: I rWVlt 4 (SOC Q V I` l() ' <br /> ro <br /> Property Owner's Mailing Address: C, 'L(p IALCO IL <br /> o <br /> Property Site Address: 3 a <br /> � {( City State Zip <br /> 1(Y1fn tl tJd l ,2 d I d O <br /> Contact's Telephone Number: (S Cl_ Z(,(z C,(o IN�AA Wro <br /> Contact's Email: 1`U t P 1 n )'.rl <br /> t7 <br /> legal Dascrintinn of property.5. <br /> Section#: Town#: N Range#:----LW Town of a I ) <br /> m <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach taxstem property * ° <br /> S7' P ro P tYPage. <br /> Tax ID#(1-5 digit number;found on tax statement): l <br /> 1 <br /> Proposed Use of Structure/Addition: 0- <br /> Sag <br /> Anticipated Start Date: Home/Cabin;Commercrat Rosiness;bedroom;Deck:etc.) <br /> Building Contractor_ b` SQ� Sewer Installer AJWA (� m <br /> BELOW TH[c I F RVED FOR Zn (C cT+LFFnrylM IVTc/rnnrnITIONcnNn y y z <br /> THIS PERMIT 1S SUBJECT TO ALL CONDITIONS LISTED BELOW: *� <br /> )*t1ofliellI YQ✓ta.vt /Si // Y Lo aiv <br /> GooriI 2 �ooP 'I& be Dpi /Nest -sle. � Fee Rec � f <br /> / 11 <br /> nn e <br /> No� �� Exctto� 9�Sr`oltwaLLf sc.r.al �Z P- cA nO' w'A1 /i1RX SiZteF aTBA yjs` <br /> Remove, Pt;v y- sX eJ/J A41W Aul/io ur <br /> z <br /> Date of staff site visit: �7 /�� In' ial of s' a vi staff: . " <br /> C <br /> ',°N Z v <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: y-�91y zo D - C� <br /> Mz v <br /> M2 0 <br /> Page I of 3 o <br /> Burnett County,W1 Land Use Application-Rev 03/2017 � Z v <br /> I <br />