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LAND USE PERMIT APPLICATION —Burnett County, WI g _ <br /> Applicant Complete All Sections Below This Line a' J <br /> Permit Types and Fees:(Check appropriate box/boxes) a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 rt <br /> `r Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> CcmmerciaUlndustrial Building $300 Addition to Commercial/Industrial Building $200 1 <br /> r %ccessory Structure(Non-Bunkhouse) $150 Bunkhouse $250 O <br /> Addition to Ace.Structure $150 Addition to Accessory Structure-Commercial(CI &11) $200 �. a <br /> Accessory Structure-Commercial(CI &I1) $200 Gazebo(WI Stat 59.692(lv)) $350 0 <br /> Deck.!Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Filling/Grading $150 <br /> Campground Screen Porches $125 Boathouse $500 <br /> Camping Unit(Six MonthstYear) $100 -o <br /> Permit Extension(Valid for one year-Only I Allowed) $100 S <br /> z <br /> *:VOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. ° <br /> *i a.^rm;mic•ar%nn Tnn�crr&S%gns renu%re a derrnt aopBcatinn form,see rnrresnnnding application and(ee_c. o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. v <br /> // (� /.,f 5' N <br /> Property Owner's Name: SQ-(Valor Mar 4 ifie.L 4 Gat � Mar'( 10 500') � z <br /> < _ <br /> Property Owner's Mailing Address: to 4q 4 Boetl e a a x Ci Inver Grove ffe.Ps, MN 5 y a <br /> Property Site Address: 23-101 0(d 35 S+'rcn , <br /> W1 54 8 72 City State Zip <br /> Contact's Telephone Number: 51 - Z83 7 g 3 9 <br /> ` 5' <br /> Contact's Email: .g Mm Ur+ ing (�D aoCom o t <br /> y <br /> Legal Description of Property: J 16 r3 g N -R 1 7 W Gbv Lof Z <br /> Darrre s ti <br /> Section#: Town#: 3$ _N Range#: 17 W Town of: .� <br /> o <br /> *9aar-h additional page if needed far lengtl?v 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): 3 O <br /> Proposed Use of Structure/Addition: S{;e cL C _ <br /> Anticipited Start Date: MCIy I t ZO1 7 (Home4Kn:WC kc- <br /> Bedroom;Deck;etc.) �► �, <br /> Shag Vahl{Or- Ervrn Llf wt (/er- © I d 1'7iC kc-ry Bu%ttin35 <br /> Bt4ding cea#aeter. 7(5- 3,57 A i t l Sewer installer: z <br /> A <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Fee Rec:—Mom <br /> x <br /> N <br /> w <br /> O <br /> m <br /> N <br /> z <br /> LIy C <br /> Date of staff site visit: / w _I Initials of site visit staff: �� oK M <br /> z z M N m 7 <br /> PFRMIT APPROVED BY ZONING OFFICIAL: DATE/.S_I/-7 A 1 �f r-1O <br /> 20 <br /> GT 0 <br /> pp SIJ <br /> Page 1 of 3 C <br /> Burnett County,WI Land Use Application—Rev 02/2017 > z (flf <br /> A <br /> m <br />