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LAND USE PERMIT APPLICATION- Burnett CountyWI Cr <br /> CLb <br /> Applicant Complete All Sections Below This Line <br /> Per Types and Fees:(Check appropriate box/boxes) 0 <br /> lling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to DwellingTrincipal Building-Multi-Family $200 O <br /> Commercial/Industrial Building $300 Addition to CommerciaVlndnstrial Building $200 t <br /> Accessory Structure(Non-Bunkhouse) $150 Bunkhouse $250 C1 d <br /> 0 <br /> Addition to Acc.Structure $150 Addition to Accessory Structure-Commercial(Cl &Il) $200 � <br /> Accessory Structure-Commercial(Cl &Il) $200 Gazebo(WI Stat 59.692(lv)) $350 0 <br /> Deck/Staks/Patio/Retaining Wall/Sidewalk/Driveway& Filling/Grading $150 w <br /> Campground Screen Porches $125 Boathouse $500 <br /> Camping Unit(Siad Months/Year) $100 <br /> a ' <br /> Permit Extension(Valid for one year-Only l Allowed) $100 <br /> z <br /> *NOTE:Afro-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. <br /> �n <br /> *Communication Towers&Signs require a different application form-,see corresponding application and fees. S t>D <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. v <br /> LnW <br /> Property Owner's Name: ep e X s) `z <br /> Property Owner's Mailing Address: Z 1 l 21 t }►2 e fi tU L i <i dlt..c c u i t/O!7 � <br /> c t <br /> p / / City State Zip G <br /> Property Site Address: Z� �� J S N /fid Irm- C� v O <br /> Contact's Telephone Number: (S Z7-Z- - 7 y ( I = � 1 <br /> Contact's Email: S k—t k ' L `'1 h o o ' f Q r� o <br /> Legal Description of Property: <br /> rn <br /> Section#: 35'- Town#: 39 N Range#: /-!r- W Town of: Z-4r Fo� <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): <br /> I <br /> Proposed Use of Structure/Addition: /wOp"`' <br /> Anticipated Start Date: /ir�( Zo (7 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> nr(Q�L <br /> BuildingContractor: Sewer Installer: <br /> I�r- P "•h.�, Z <br /> N <br /> AREA BELOW THIS LINE RESERVED r OR ZGNING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> �2C��(�ec7 elYr� vf/I� Sc�1 FeeRec: 'bC <br /> M �, � S I S e�k' � �►'a�k Se✓�Ua�k d <br /> n <br /> W Z m <br /> Date of staff site visit: Initials of site visit staff: Sa a M co <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE:3 0 <br /> Z J <br /> Page 1 of3 <br /> Burnett County,WI Land Use Application—Rev 02/2/2017 > �� <br /> 3 <br /> ^a <br /> x <br /> m <br /> a <br /> m <br />