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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) ° <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 \ <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 O <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 ( 1 <br /> Accessory Structure(Non-Bunkhouse) x $150 Bunkhouse - $250 <br /> oAddition to Acc.Structure $150 Addition to Accessory Structure-Commercial(CI &11) $200 <br /> Accessory Structure-Commercial(Cl &11) $200 Gazebo(WI Stat 59.692(lv)) $350 0 <br /> Deck/Stairs/Patio/Retaining Wa0/Sidewalk/Driveway& Filling/Grading $150 iv <br /> 2 <br /> Campground Screen Porches $125 Boathouse $500 m' <br /> Camping Unit(Six Months/Year) $100 �y <br /> m <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 S . <br /> Z <br /> *NOTE.After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. (,t <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. 1 <br /> *Items not listed above will be treated as accessory stnichtres,such as:pergolas,landscaping,etc. <br /> n <br /> a <br /> G6� b <br /> Property Owner's Name: ,�.-t.l�t �- w;n e. .I' � r z <br /> O <br /> Property Owner's Mailing Address: Ff0 -S S 1 r.R_ T3 Cs3� 3 a <br /> City State Zip o b <br /> Property Site Address: lo—i"3 CSM ✓a?,_2 e a (e_ 1 91 <br /> o t <br /> Contact's Telephone Number: 715-- 4 ( 0- Ll ( R k N <br /> Contact's Email: {� e e 2r �3F tyt c� tai•,-t <br /> d <br /> Legal Description of Property: d5an VA2, •PaL 3. <br /> Section#: Town#: N Range#: W Town of: //lGCrl6{t 1 <br /> E <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page. <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: IFAej <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: OLA,y-e-r Sewer Installer: 6/4 z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITION� LIS1TpED BELOW; <br /> a ejc� e r <br /> Z <br /> Z m <br /> T <br /> L oo <br /> Date of staff site visit: �a I ials of site visit staff N n <br /> O <br /> z8 1. t� <br /> PERMIT APPROVED BY ZONING OFFICIAL DATE. Q C , <br /> Page 1 of 3 <br /> Burnett County,WI Land Use Application—Rev 1/2017 <br />