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LAND USE PERMIT APPLICATION—Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line rE J <br /> Permit Types and Fees:(Check appropriate box/boxes) a <br /> P <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 n <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 O <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> ✓ Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> F <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 <- <br /> Accessory Structure-Commercial(Cl &Il) $200 Addition to Accessory Structure-Commercial(Cl &11) $200 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 y <br /> m <br /> Cam oundStructures <br /> P!g $125 Filling/Grading SI50 <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 ,y <br /> rn <br /> Permit Extension(Valid for one year-Only I Allowed) $100 <br /> z <br /> *NOTE:After-the-fact(when no pertnit 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. o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. g <br /> n <br /> Property Owner's Name: rc <br /> Su tJ e, C t /�/.Rec/ _5 �"E.e ro <br /> # <br /> Ur <br /> Property Owner's Mailing Address: a Wr a <br /> City State Zip C7 <br /> Property Site Address: r�471� M.�iGed✓t �� _��,ty[�u <br /> Contact's Telephone Number: I/-'/']-7 0 � <br /> O l <br /> 5' <br /> Contact's Email: o <br /> m 1 <br /> Legal Description of Property:_'G�fA <br /> rn <br /> Section#:�_Town#:_YLN Range#: /6 W Town of: _5,v/ss 1 I 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): a 30 3 y <br /> Proposed Use of Structure/Addition: Gam,-et.s <br /> Anticipated Start Date: f15AP (Home/Cabin;Commercial Business;Bedroom;Deck;etc) <br /> Building Contractor: Sewer Installer: y z <br /> w <br /> A <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY SU <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: O <br /> Fee Rec: CJV <br /> �i <br /> N <br /> y <br /> V <br /> ti] <br /> N <br /> O <br /> Z <br /> nW <br /> �f H 47 Y <br /> Date of staff site visit: 141 / Initials of site visit staff: � / � � � <br /> z ern <br /> PERMIT APPROVED BY ZONING OFFICIAL: ATE: 3 z ea <br /> � o <br /> m 170 N <br /> Page 1 of 3 0 z o <br /> Burnett County,WI Land Use Application-Rev 03/2017 <br /> 'yb' <br /> 1' <br /> [S1 <br />