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LAND USE PERMIT APPLICATION- Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Check appropriate bWboxes) <br /> v <br /> Daellinr/Principal Building-Single Family $300Addition to 1)ne)linglPtiocipal Building-Single Family S200 rp <br /> Dwelling(Principal Building-Multi-Family $300 Stwe <br /> Structural Alteration to Dlling/Principsl Buildings 5200 <br /> CommerciaVlndwrial Building 5300 Addition to CommercialAnd atrial Building $200 <br /> NIX Accessory Strurture(Non-Bunkhouse) $150 Addition to Accessory Structure SI50 <br /> L) <br /> Bunkhouse S250 Structural Alteration to Accessory Structure $150 '� < <br /> Accessory Structure-Commercial(Cl &II) 5200 Addition to Accessory Structure-Commercial(Cl &11) 5200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Gzebo(WI Stat 59.692(Iv)) $350 N <br /> m <br /> Campground Structures 5125 Filling/Grading $150 R. <br /> 4Camping Unit(Six Months Per Year) $100 Boathouse $500 :a <br /> m <br /> Permit Extension(Valid for one year-Only I Allowed) $100 <br /> o <br /> z <br /> "NOTE.After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. <br /> "Communication Tmvers&Signs require a di ermt lieation orm,see eorrff ndin a lim ion mid � <br /> t8^� e9 Il WrP J 1M 8 1>n fir. <br /> "Items not listed above will be treated as accessotystruchires,such as:pergolas,landscapinp,etc. <br /> r. n y <br /> Property Owner's Name:- 5 �/ /T���/ c�!✓ 3 <br /> Property Owner's Mailing Addrem: 36001)2691-169X77,2+ /Gl y✓ _ o a <br /> �? Q City State Zip v <br /> Property Site Address:_ p 360 / 1,yXS' z`SrJI P, m <br /> F <br /> Contact's Telephone Number: <br /> a <br /> 6 <br /> Contact's Email: Ad2U,+ lAiC--S (6V <br /> Legal Description of Property: 1-07 ( , 910 e C l � Ttf e- ?/,NI 5. � <br /> Section#:- Town#:�/-QN Range#: 7 W Town of: UA,70 (Y k� <br /> o I <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): <br /> Proposed Use of Structure/Addition: 64A§2 <br /> ated Start Date: r <br /> Antici <br /> p �/�% � �a[rJ17 (Home/C,ahin,'Commercial Bnsinecr:Bedroom:Deck:mac.) <br /> m <br /> Building Contractor: Sewer Installer: z w <br /> z <br /> AREA BELOW TI LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> yFeeRec:�� <br /> b <br /> X1/,5 y 201 N <br /> N <br /> 0 <br /> s � <br /> n R <br /> Date of staff site visit: Initials of site visit staff: Z C <br /> t.� 1—� <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: S Z 7 ora t1VU <br /> Page 1 of 3 o Z ti <br /> Burnett County,WI Land Use Application—Rev 03/2017 <br />