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LAND USE PERMIT APPLICATION - Burnett County, WI a C <br /> b <br /> N y � <br /> Applicant Complete All Sections Below This Line v <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> Dwelling/Principal Building-Single Family $300 Addition to Dsvclhg/Principal Building-Single Family $200 <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 /> C1 � <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 < <br /> Accessory Snucture-Commercial(Cl&11) $200 Addition to Accessory Structure-Commercial(CI &11) $200 o <br /> Deck/Stairs/Patio/Retaining WalUSidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 <br /> Campground Structures $125 Filling/Grading $150 W <br /> mW <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 <br /> m <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 r- <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 Towers&Signs require a different aPPlicationform,see corresponding application andfees. <br /> g <br /> *Items not listed above will be accessory as accessory.structures.such as:pergolas, landscaping,etc. o <br /> Property Owner's Name: Qogir �roA tJcrA/i ht YLD�` e 4 z <br /> Property Owner's Mailing Address: Z 7 3 P viv,,a <br /> c <br /> St C - <br /> �Gi� City State Zip <br /> Property Site Address: Z o <br /> ? J/� 7 �l/�G�( 2 . W G✓� �/ S�l�'f,3 �; <br /> Contact's Telephone Number: <br /> 0 <br /> 5' <br /> Contact's Email: VIP <br /> b <br /> Legal Description of Property: Ld Z- Cf^ V l / <br /> Section#: Town#: N Range#: W Town of: o'a <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> Tax ID#(1-5 digit number; found on tax statement): 9 92 7/ —1 1 <br /> Proposed Use of Structure/Additdion: .S'f kYS f d Lt( <br /> 4 'L <br /> Anticipated Start Date: 5h (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) (� <br /> Lt�1 kG <br /> Building Contractor: 4 OW016 Sewer Installer: z <br /> V N <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LIS1TED BELOW: <br /> 0, �,YY1 d\ V� I C)1 �v I CUA f c7 I I )✓� <br /> Fee Rec: QD <br /> s <br /> y <br /> Vi <br /> M <br /> z <br /> z <br /> n <br /> Date of staff site visit: Initials of site visit staff: <br /> �1 > Z C <br /> com <br /> ^ r <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: f ,, J <br /> ® c <br /> H C ti <br /> Page 1 of 3 0 z Cly <br /> Burnett County,WI Land Use Application—Rev 03/2017 <br /> m <br />