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LAND USE PERMIT APPLICATION-Burnett County WI r 0 r <br /> ~ Cy <br /> � � V <br /> Applicant Complete All&-etalons Below This Litre n' y r+ <br /> Permit Types and Fees:(Check appropriate box/boxes) g �� <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dvxlling/Priacipal Building-Single Family $200 A tM <br /> D%wilin rinci al Building-Multi-Family 5300 Structural Alteration to Dwelling/Principal Building 5200 <br /> Commercial/Industrial Building S300 Addition to Commercial/Industrial Building $200 ry <br /> 'Accessory Structure(Non-Bu,khousej $150 x Addition to Accessory Structure $ISO <br /> O <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 < <br /> Accessory Structure-Commercial(CI &11) $200 jAdditiun to Accessory Structure-Commercial(Cl &Il) 5200 c <br /> Deck/Staitsft afioRtetaiWng Wail,S&vvalkA)riveviay ffi Gazebo(WT Stat 59.692(l v)) $350 <br /> m <br /> Campground Structures $125 Filling/Orad'mg $150 Z <br /> 6 <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 a <br /> Permit Extension Valid for one year-Onl 1 Ahoy- $100 1 <br /> t <br /> I <br /> *NOTE After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. 0� I I. <br /> *Communication Towers&Signs require a derent application form,see corresponding application and Dees. g +++---------- <br /> 'Items not listed above will be treated as accessory structures,such as:pergolas,landscopin ,etc•. Cn <br /> ,a <br /> Property Owner's Name: &fA} S[ YtJt t{ 17 0� ►ten. N i 5 e t1 6 `tl <br /> O m <br /> Property Owner's Mailing Address: 300 gS (7j,f Tr I. YYl N S-3-0-+9 <br /> a <br /> City State Zip a <br /> Property Site Address: 123 I Ca a i1� i-d 67. 1�o 6 rxLe t W t Sti{ 1 <br /> Contact's Telephone Number: (o i Z , -707- , F S 3 2 <br /> ��'11 <br /> �• t <br /> Contact's Email: b S di ir LF Q o^1i er A t.+ • A e-} <br /> Legal Description of Property: <br /> ly <br /> Section#: Town#: N Range#: W Town of � y <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): .1 <br /> Proposed Use of Structure/Addition: Wer "h C 9 <br /> Anticipated Start Date: (c I 2 c 17 (Hnme/Cabin;Cnmmercial Basiners;Bedroom;Deck;etc.) <br /> Building Contractor: Sewer Installer: z (� <br /> 7y '� <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Allr a tv� o cel 6"c-y <br /> )-� ,6/bh? Am a h1, lik a ae, Fee Rec: <br /> �e issu y <br /> 4-o �4cc Aid/�'�) ° <br /> z OD <br /> Date of staff site visit: Initials of site visit staff: RI z <br /> PERMIT APPROVED BY ZONING OFFICIAL 44�Y7� DATE: 6- 6 -0- <br /> LIZ I <br /> N r-' <br /> O <br /> Pagc 1 of 3 I ti <br /> Burnett County,WI Land Use Application—Rev 03/2017 <br /> s <br /> 9 <br /> S <br /> m <br /> z <br /> m <br />