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' LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> 0. <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> v <br /> Dwelling/Principal Bwlding-Single Family $300 Addition to Dwelling%Principal Building-Single Family $200 V <br /> Dwelling'Principal Building- Multi-Family $300 Structural Alteration to Dvelling,?rincipal Buildings $200 O <br /> Commercial/Industrial Building $300 Addition to CommerciaVIndustrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 1 <br /> c <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 < <br /> Accessory Structure-Commercial(CL & 11) $200 Addition to Accessory Structure-Commercial(Cl &I11 $200 0 <br /> Deck/StairsiPatio/Retaining Wall/Sidcwalk/Driveway& Gazebo(WI Stat 59.692(Iv)) $350 <br /> Campground Structures $125 Filling'Caading $150 <br /> P <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 7 <br /> r, <br /> Permit Extension(Valid for one year-Only I Allowed) $100 r- <br /> o ❑ <br /> Z <br /> *NOTE: After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. t <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc D <br /> Property Owner's Name: bCe'✓Nl) LjS�Pr-Ickso J SU <br /> Property Owner's Mailing Address: 65e23 3"_ kae A tj <br /> 6L/ <br /> ff City State Zip o <br /> Property Site Address: 6L//N9 l►►l ��.� �CL Scrr.. SS�f�72 <br /> Contact's Telephone Number: �� /$ � � <br /> Contact's Email: %LN' Do 4�r0t_-IZ" 7 I nAj l Cc+VN � w <br /> Legal Description of Property: �� L Gov L04 £ !V f- 1 <br /> � 1 <br /> Section 1#: Town#:T 3 p 1 N Range#: Q 1_ W Town of: Q��•1 _ __ <br /> o' <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): J 1143 <br /> - <br /> Proposed Use of Structure/Addition: Cct i r\ <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc) <br /> C C1 <br /> Building Contractor: Sewer Installer: � z <br /> z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALLi CONDITIONS LISTED BELOW: <br /> r <br /> Fee Re�� e�� <br /> 5 <br /> ' G <br /> Un <br /> Date of staff site visit: Init' is4f * visit staff: <br /> r`a <br /> _ <br /> PERMIT APPROVED BY ZONING OFFICIAL DATE: 1 , <br /> go <br /> e> <br /> Page 1 of 3 e —' <br /> Burnett County, WI Land Use Application—Rev 03/2017 <br /> x <br /> m <br /> z <br /> rn <br />