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rA <br /> LAND USE PERMIT APPLICATION - Burnett County WI a ro <br /> Applicant Complete All Sections Below This Line o' c v <br /> Permit 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 £ <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 1 <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> � l <br /> Bunkhouse $250Structural Alteration to Accessory Structure $150 < <br /> Accessory Structure-Commercial(CI & 11) $200 Addition to Accessory Structure-Commercial(Cl &11) $200 c <br /> Deck/Stairs/Patio/Retaining Wall/Sidewallt/Driveway& Gazebo(WI Stat 59.692(lv)) $350 Cn <br /> Campground Structures ? —• <br /> Pg� $125 Filling/Grading $150 <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 <br /> m <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 r <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 <br /> corresponding application and fees. o <br /> 'items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ti <br /> Property Owner's Name: !\�I/1 �J�{��"1 {/ r 2 <br /> �^ n 2. <br /> C y <br /> Property Owner's Mailing Address: v tJ /xr/r&19 dZ a t <br /> �as ���'S�`(� nG� City State Zip d <br /> PropertySite Address: �,�Glt/✓j /.(J/ '= <br /> 1 <br /> Contact's Telephone Number: <br /> lL ?'6 _cZe{5—U-67y/0 o w <br /> Contact's Email: 67{7�j j� /vt y� ✓� /y/�i �. G oyf <br /> L / N <br /> Legal Description of Property: �( �Q' p �9. Ir o F U '�j <br /> Section#: X�Town#:"_tv xange�;r �TW -I'dwri Gr. UA)16 V Q� � 6' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* l n <br /> Tax ID#(1-5 digit number;found on tax statement): o�SOS' 141 <br /> Proposed Use of Structure/Addition:-Ga VYs g' Acce S5o n j S I/LreQ <br /> - a <br /> Anticipated Start Date: . 017 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor:� Sewer Installer:__ <br /> y <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIOPiS LISTED BELOW: <br /> Fee Rec: M6.tv <br /> x <br /> fA <br /> N_ <br /> 0 m <br /> O <br /> n Z c <br /> r- <br /> Date of staff site visit: Initials of site visit staff:N"_ \ <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: j 0 C=C: <br /> v <br /> Page 1 of 3 <br /> Burnett County,WI Land Use Application—Rev 03/2017 <br /> x <br /> M <br /> a <br /> m <br />