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LAND USE PERMIT APPLICATION— Burnett County, WI g Z <br /> s. <br /> licant Complete All Sections Below This Line g <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> U%wiling/Principai Building-Single Family $300 MAddition to D ciling/Prmcipal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to D„elling/Principal Buildings $200 v <br /> Comm erciaUlndtstrial Building $300 Addition to Commercial/Industrial Building $200 <br /> 4 <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $ISO <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 <br /> Accessory Structure-Commacial(Cl&Il) $200 Addition to Accessory Structure-Commemial(Cl&II) $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 W <br /> Campground Structures $125 Filling/Grading $150 <br /> Cam in Unit(Six Months Per Year) $100 Boathouse S500 <br /> 0 <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 <br /> .. o*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. Q� <br /> *Items not fisted above will be treated as accessory structures,such as:pergolas, limiscaphig,etc. <br /> Property 3;M mcxrel�e SDr enso r N ro <br /> Pro Owner's Name: <br /> Property Owner's Mailing Address: 0111332 (P ZS7' S-k ssoe) An 55gy � <br /> Property Site Address: a 7 g P01 r)t L0tkk Tl� IJ "�� � Zip <br /> Contact's Telephone Number: 60 7` 4 a( — 4"1 to <br /> S' <br /> Contact's Email: I`tl0.t`e1�er�0C'QPJC�SiJn gMai1./C�JDM g <br /> Legal Description 1/' <br /> onnofProperty: L.o �3 M ! 9� <br /> Section#: 2,iTown#: /-/0 N Range#: W Town of: a SOS rn <br /> H <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> l <br /> Tax ID#(1-5 digit number,found on tax statement): <br /> Proposed Use of Structure/Addition: cabi`t hPo,X=yn .S t&-n r ooh <br /> Anticipated Start Date: (HomelCabi i,Commercial Business,Bedroom;Deck,etc.) <br /> 0 <br /> Building Contractor. Sewer Installer: Z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Fee R <br /> N <br /> y <br /> Pf <br /> C <br /> X <br /> Date of staff site visit: Initials of s' a visit staff: Z n �U <br /> PERMrr APPROVED BY ZONING OFFIC JDATE: <br /> 40 <br /> O <br /> C <br /> Page I of 3 6Z �'ll <br /> Burnett County, WI Land Use Application— Rev 03/2017 <br />