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LAND USE PERMIT APPLICATION - Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line ; Ir2 1 <br /> Permit Types and Fees:(Check appropriate box/boxes) ° <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 \ <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 O <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 1 <br /> Bunkhouse $250 <br /> Accessory Structure(Non-Bunkhouse) $150 1 <br /> n <br /> 0 <br /> Addition to Acc.Structure $150 Addition to Accessory Structure-Commercial(Cl &It) $200 <br /> Accessory Structure-Commercial(Cl &11) $200 Gazebo(Wl Stat 59.692(l v)) $350 S _ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway $150 rn <br /> Sidewalk/Driveway& � <br /> Campground Screen Porches $125 Boathouse $500 d' <br /> Camping Unit(Six Months/Year) $100 <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 S <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 /> */terns not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: P/2/ e Le I Ajz <br /> Property Owner's Mailing Addressfio8wltc—es r6iC tv i Sy Py 3 a <br /> City State Zip o <br /> Property Site Address: 101>1> C/e S 7 <br /> Contact's Telephone Number: 7 5 - 3 3 e 9I 5 <br /> o� <br /> I <br /> Contact'sEmail: V l aZ �e IA27% t t 7(� a D - Coi 11 <br /> - d I <br /> Legal yecsscription V. roperty: LCT-5S r b 13 a e- 9 /9 M 13rdoKS <br /> Sec toff# iJ(/fELp STlown#: 4/ N Range#: UP Town of: 51t)/ 5.5 y <br /> 0 <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): '�a 39 as 2.7 y 1) ` 1 <br /> Proposed Use of Structure/Addition: I4-CC 2 55 U v U 5 to cfk r 2 I <br /> Anticipated Start Date: (Home/ abin;Commercial Business;Bedroom;heck;etc.) , <br /> Building Contractor: Sewer Installer: z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY Cy <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 0 <br /> Fee Recj,-12�),r <br /> Date of staff site visit: Initials of site visit s aff: <br /> PERMIT APPROVED BY ZONING OFFICIAL: 10,A DATE: lol-30-Me <br /> Page 1 of 3 <br /> Burnett County,WI Land Use Application—Rev 10/2016 <br />