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LAND USE PERMIT APPLICATION-Burnett County, WI R ro ct <br /> Applicant Complete All Sections Below This Line $ ; <br /> a t\ <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> Dwelling/Principal Bolding-Single Family $300 11 Addition to Dwelling/Principal Bolting-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family 5300 Structural Alteration to Dr elling/Principal Buildings $200 <br /> Commescial/Ind striat Bolding $300 Addition to Commercial/IndustrW Building 5200 \ rn <br /> Accessory Structure(Non-Btnkhouse) / 5150 Addition to Accessory Structure 5150 C. <br /> Bunkhouse 11 5250 Structural Alteration to Accessory Structure 5150 < <br /> Accessory Structure-Commercial(Cl&I1) 5200 Addition to Accessory Structure-Commercial(Cl&Il) $200 <br /> Deck/Staits/Patio/Retaming Wall/Sidewwlk/Driveway& Crazebo(Wl Stat 59.692(lv)) 5350 <br /> Campground structures $125 Fdlmg/Crading 5150 <br /> CampingUnit(Six Months Per Year) $100 Boathouse $500 <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 0 . <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 d fferent applicnWon form,see corresponding application and jeer. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,kindscaping,etc. .d <br /> Q�� iCNio2 - ,a <br /> Property Owner's Name: <br /> lis Vt { o m <br /> Property Owner's Mailing Address: ����r `O /ice' '` �- J g, C� <br /> a ,��/ City State Zip a <br /> Property Site Address: /� 3�3 �) /1 AFi^ ff <br /> ,. <br /> Contact's Telephone Number: 9Pt2 <br /> ] <br /> Contact's Email:/]-OG 2 oc <br /> AE' <br /> Pal <br /> / t' <br /> Legal Description of Property: PGI 2 c� W1 G P•31t tdvf o4w- -Ill� <br /> Section#: 2,1_Town#: 4/0 N Range#:-1�f- _W Town of ___,5Ce0 7y` <br /> ' ` LII91J <br /> 'Aaach additional page rrneededjor lengthy descriPtion OR attach a copy of the deed OR attach tax system prop pqge. <br /> H <br /> Tax ID#(1-5 digit number;found on tax� A statement): _� /g H d <br /> Proposed Use of Structure/Add' " n: n .,-1a,✓Ge i,�e2gf 4e <br /> Anticipated Start Date: P7 (flome/Cabin;Commercial Business;Bedroom;Derck,etc.) ��J <br /> Building Contractor: Sewer Installer: No FOOT serves W• z <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 A2D <br /> w <br /> 6 <br /> m <br /> z <br /> z <br /> —j <br /> Date Date of staff site visit: —� Initials of site visit staff:�� w M <br /> � ^ <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE �S / z Q fll r 45 O <br /> � Z :4 t� <br /> Page 1 of 3 GG)O o <br /> Burnett County,WI Land Use Application—Rev 03/2017 y Z �+ <br /> Q <br />