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If <br /> En <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line c I <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> D%wiling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> D,celling/Prinmpal Building-Multi-Family $300 Addition to MwIling/Prmcfpal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaUlndustrial Building $200 ( �, <br /> Accessory Structure(Non-Bunkhouse) $150 Bunkhouse $250 <br /> o � <br /> Addition to Acc.Structure $150 Addition to Accessory Structure-Commercial(C1 &11) $200 <br /> Accessory Structure-Commercial(Cl&11) $200 Gazebo(WI Stat 59.692(lv)) $350 <br /> $150/Grading n <br /> Deck/Stairs/Patio/Retaining Wail/Sidewalk/Drive„ay& Fillingm <br /> Campground Screen Porches $125 Boathouse $500 <br /> Camping Unit(Six MonthsRear) $100 � <br /> a <br /> Permit Extension(Valid for one year-Only 1 Alloyed) $100 c _ <br /> z <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *hems not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: K <br /> O y <br /> Property Owner's Mailing Address: o <br /> �/� /� Q I Ci State Zip a <br /> Property Site Address: �&!a i 6e% n� f�pUt. U�L t W k �RX) <br /> Contact's Telephone Number: <br /> Contact's Email:a5Q1 Kot)Ch5CC)n k4d Cep <br /> //��•�`` AAAA �J�• t7 <br /> Legal Description of <br /> y <br /> Section#:�_Town#:-40 N Range#: W Town o£ <br /> 0 <br /> *Attach additional page if needed for lengthy description ORattacha copy of the deed OR attach tax system property page.* <br /> ,� <br /> Tax ID#(1-5 digit number;found on tax statement): 4t L 53 l 51 <br /> Proposed Use of Structure/Addition: Pccme L_ <br /> Anticipated Start Date: %V AAlL aQ L'7 (Flome abin;Commercial Business;Bedroom;Ikc$etc.) r- <br /> Building Contractor: CbA S��' C ex.lw r) Sewer 1nstaller:�4/1$SQ,1d a-&1W( n z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY ) <br /> // THI1S, PERMIT IS SUBJECT TOA L CONDITIONS LISTED BELOW: U� <br /> l__ e�7 t`S tc 0� Sit Nom. 6- 0 c 6\1 <br /> C7m •,n� 6-f"Cit, Fee Rec- <br /> e rcp_ p CY o O NW N\ o„ sm <br /> Date of staff site visit: -5-5 — I ! Initials of site visit staff- —7 <br /> PERMIT APPROVED BY ZONING OFFICIALAZO DATE —)�'] / <br /> Page 1 of 3 <br /> Burnett County,WI Land Use Application —Rev 1/2017 <br />