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LAND USE PERMIT APPLICATION —Burnett County, WI c <br /> 0. <br /> Applicant Complete All Sections Below This Line a <br /> a � <br /> Permit Types and Fees:(Check appropriate box/boxes) o <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 K <br /> g <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 O <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 <_ <br /> Accessory Structure-Commercial(Cl&11) $200 Addition to Accessory Structure-Commercial(CI &11) $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 H <br /> m <br /> Campground Structures $125 Filling/Grading $150 <br /> m <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 <br /> 0 <br /> Permit Extension(Valid for one year-Only I Allowed) $100 5. <br /> z <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three rimes the normal fee. ° <br /> *Communication Towers&Signs require a different applicationform,see corresponding application andfees. <br /> o <br /> n <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. ,o <br /> Property Owner's Name: /'116/7/4 EL IQ l�66 <br /> -72 <br /> G /� S/HE/V 5yt� Z_ <br /> ? v <br /> Property Owner's Mailing Address: 5 0 E 0 S o U)/ g <br /> a <br /> I&A <br /> v(/ C7State Zip o <br /> Property Site Address: ��i Z� 3 (�%KE l�GI&A <br /> I <br /> Contact's Telephone Number: 7/5 - 3q1-,-; S_05_ <br /> o b I <br /> 0 <br /> Contact's Email: PO L E5 rA k Z(F M F, 60 61 p ti <br /> Legal Description of Property: SE if A I-TA C/-/!_/-) <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additionalpage 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): 5 r 114 YA� /j f= D /y✓ I y_ I <br /> Proposed Use of Structure/Addition: C A kA G E A N n U42 SIC 5/40/0 <br /> Anticipated Start Date: Sjiy c7 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: G SNC 61/7L EIV Sewer Installer: /V// 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: I <br /> Fee Rec:]M—,X <br /> rn <br /> �(A <br /> v <br /> z <br /> SIS <br /> Date of staff site visit: In 'als of site 'sit staff. <br /> too <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: 3_ *) <br /> 452 <br /> Page 1 of 3 1iit <br /> Burnett County,WI Land Use Application—Rev 03/2011 a �� <br /> x <br /> m <br /> m <br />