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LAND USE PERMIT APPLICATION - Burnett County, WI F r <br /> b <br /> Applicant CoutIrletv.All Sections Below This Line _ <br /> a <br /> Per it 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 Structural Alteration to Dwelling/Principal Buildings $200 O <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 1 <br /> Accessory Structure(Non-Bon khouse) $150 Addition to Accessory Structure $150 <br /> Ct <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 Vit, <br /> Accessory Structure-Commercial(Cl &11) $200 Addition to Accessory Structure-Commercial(Cl &11) $200 <br /> 692(lv)) $350 m <br /> Deck/$[airs/Patio/Retaining Wall/Sidcwalk/Driveway& Gazebo(Wl Stat 59. �' 11 <br /> Campground Structures $125 Filling'Grading $150 <br /> v <br /> Camping Unit(Six Months Per Year) $100Boathouse $500 b <br /> rn <br /> Pennit Extension(Valid for one year-Only 1 Allowed) $100 t" <br /> 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 different application form,see corresponding application andfees. °o <br /> *Items not listed above will be treated as accessory structures,such as pergolas, landscaping etc. <br /> Property Owner's Name:_c i^ (f-r y ,,P_V' 3 z <br /> Property Owner's Mailing Address: Lf C Ck 1 to wa� 7 �a cP�t�t S J d 3a <br /> City State Zi C7 <br /> Property Site Address: xL \1��-N 4 T��ye- e LgJs -14 ky <br /> Contact's Telephone Number: C� / d �� f <br /> Contact's Email: G+ '�-S �� _'1✓ /J��+�`�j <br /> Legal Description of Property: 1 A, I t��r�to, <br /> Section#: F5 Town#: N Range#: `� W Town of. v ' <br /> o <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): k��l 1 <br /> Proposed Use of Structure/Addition: <br /> /Addition:pot -7 <br /> � <br /> Anticipated Start Date: � p o r —7 ( ome/Cabin, Commercial Business;Bedroom;Deck;etc.) <br /> n 1 <br /> Building Contractor: Sewer Installer: A T- qq 9 'C _ z <br /> 77 <br /> AREA BELOW THIS LINERESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> vrN 4- <br /> Fee Rec3t,/�� <br /> M <br /> Date of staff site visit: —�—s _ Initials of site visit staff: :Z C <br /> r <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE <br /> Page 1 of 3 :ZV <br /> Burnett County, WI Land Use Application —Rev 03/2017 <br />