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~ LAND USE PERMIT APPLICATION—Burnett County, WI g <br /> Applicant Complete All Sections Below This Line � <br /> Permit Types and Fees:(Check appropriate box/boxes) n <br /> a � <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family 5200 n <br /> Dw 11inF/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings S200 v <br /> COmmercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 1 <br /> Accessory Structure(Non-Bunkhouse) 5150 jAddition to Accessory Structure $150 <br /> n <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $15 < <br /> Accessory Structure-Commercial(Cl &11) S200 Addition to Accessory Structure-Commercial(Cl &Il) $200 S <br /> Dwk/Stairs/Patio/Retaining Wa1VSidewalk/Driveway& Sabo(WI Stat 59.692(lv)) 5350 <br /> Campground Structures S125 Filling/Crading $150 <br /> Camping Unit(Sic Months Per Year) $100 Boathouse $500 <br /> m <br /> Permit Extension(Valid for one year-Only 1 Allowed) S100 3 <br /> z <br /> •NOTE After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. - ,a <br /> 'Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> •Items not listed above will be treated as accessorystrucho-es,such as: las,landscaping,etc. <br /> Property Owner's Name: tyktc.y � u <br /> c � <br /> Property Owner's Mailing Address: A)//o t: w n fC %r 1 'C l"V 15 1/8l n <br /> City State Zip C7 1 <br /> Property Site Address: 17'!/ (.041'fe PfN-e f!'Irl Jr/tJt,:�t w S'�X37 i <br /> Contact's Telephone Number: 3 to" ;L79- U' 3 ti a w� <br /> o t <br /> m <br /> Contact's Email: SS v — tyu4"C'. coo, 9 <br /> Legal Description of Property: 7 -63 y-ol -3 7-/9-1.1-,S75 -V7'6Zaaz <br /> Section#: Town#:_&JAI N Range#: W Town of: /1Y.tr.'14, <br /> o <br /> `Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage.' TTT <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: & f'g4. <br /> Anticipated Start Date:�j�NL�/� (Nome/Cabm;Commercial Business;Bedroom;Deck,etc.) <br /> C7 <br /> Building Contractor: Sewer Installer: <br /> 50 <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:15iom <br /> I ~ <br /> � M <br /> m <br /> N <br /> z <br /> z <br /> W 0 <br /> J <br /> Date of staff site visit: Initials of site visit teff: M� Z � <br /> 0 n <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: tN <br /> Z O <br /> m <br /> Page 1 of 3 o Z <br /> Burnett County,WI Land Use Application—Rev 03/2017 _ <br /> M <br /> A <br /> m <br />