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LAND USE PERMIT APPLICATION — Burnett County, WI70 <br /> a _ <br /> y <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwtaling/Principal Buildings $200 <br /> O <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 1 <br /> Accessory S[ructure(Non-Bunkhouse) $150 Addition to Accessory Structure <br /> 'Bunkhouse $250 Structural Alteration to Accessory Structure $150 <, <br /> Accessory Structure-Commercial(CI &11) Addition to Accessory Structure-Commercial(CI & 11) $200 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 d <br /> Campground Structures $125 Filling/Grading $150 <br /> w <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 <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 and fees. M <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a <br /> rA <br /> Property Owner's Name: doa.n(A r * N, u)t e (St 11,'44,-,d- <br /> o <br /> Property Owner's Mailing Address: t{ S. m 1S iti1 N SSS// a <br /> City State Zip d <br /> Property Site Address: a.9 yy.2 Long L,(e Rd <br /> Contact's Telephone Number: -Gi 'a 3 7 - 5-6 6 ff N w t <br /> t� 1 a' <br /> Contact's Email: hl LahoO KdWto,n t-- y 2n�u r tS .Go r►1 d <br /> N <br /> Legal Description of Property:- L 'f �7- ^ � NwSArL �Ge er�S `^ <br /> Section#: Town#: N Range#: /r _W Town of: SGoTr— <br /> 0 11 <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):_ / y <br /> Proposed Use of Structure/Addition: 104D r/,1- 5 ho p - d?-VO)A) <br /> Anticipated Start Date: 7-0-11 (HomefCabin;Commercial Business:Bedroom;De ;etc.) <br /> 11 n <br /> Building Contractor: 6Gl _S6to --5�S wer Installer: ?5 S -rd 1 lc J-4 y z <br /> y <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Fee Re <br /> cj3z <br /> y <br /> N <br /> d <br /> m <br /> N <br /> O <br /> C1 <br /> Date of staff site visit: Ini ials of site visit staff: r Z C <br /> 9M z <br /> PERMIT APPROVED BY ZONING OFFICIAL DATE:61 <br /> eo tri <br /> <C: <br /> Page 1 of 3 `lf <br /> Burnett County,WI Land Use Application-Rev 03/2017 <br /> t <br /> x <br /> M <br /> a <br /> m <br />