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LAND USE PERMIT APPLICATION — Burnett County, WI rr�3 <br /> Applicant Complete All Sections Below This Line `r <br /> Permit Types and Fees:(Check appropriate box/boxes) °L <br /> o <br /> Dvvellin Princi al Building Nagle Family $300 1 Addition to D%%ellingdlrincipal Building-Single Family $200 01 <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 <br /> Commercial/Industrial Building $300 lAddition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) $150 jAddition to Accessory Structure $150 -' <br /> o <br /> Bunkhouse $250 St ructuval Alteration to Accessory Sticture $150 <br /> Accessory Structure-Commercial(Cl &II) $200 Addition to Accessory Structure-Commercial(Cl &I1) $200 p �� <br /> Deck/Stairs/Patio/Retaining WalUSidewalk/Drivevay& ebo(WlStat 59.692(Iv)) $350 y <br /> m <br /> Campground Structures $125 Filling/Grading $150 �LL <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 �s <br /> ro <br /> Permit Extension(Valid for one year-Only I Allowed) SI00 r. <br /> o <br /> z _ <br /> *NOTE:After-the-fact(vvhen no permit is obtained prior to construction)is up to three times the normal fee. P <br /> *Communication Towers&Signs require a different applicationform,see corresponding application and/ees. =� <br /> ..� <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. $� <br /> Property Owner's Name:Ci1Q.IS'T'O pliEQ. 1[J('T�X���!■. � � <br /> Q y u <br /> Property Owner's Mailing Address: -T p4 a no. <br /> a <br /> �y t,, �_ 1 C•ty State Zip o <br /> Property Site Address:21S145 �,"T tak f iCc�S a e��LIC WX �$31 <br /> Contact's Telephone Number: tt Z - <9 10 - 2-786 a e ) <br /> e <br /> Contact's Email: � it �t ) t N�OQ.� C� CtathC45T , tJE / o <br /> // � t <br /> Legal Description of Property:ZaT y/j�y ?A2 j T_!;- /oA[EjAs p�✓J] � <br /> I <br /> Section#: Town#: N Range#: W Town of:T/LAChE (JI►kE <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> I <br /> Tax ID#(1-5 digit number;found on tax statement): 3MCX2) —I <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: (Home/Cabin;Commercial Business.Bedroom;Deck.etc.) <br /> rn <br /> Building Contractor: Sewer Installer: z I <br /> N <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PLERMI/T�IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> �r's PutM17 i� Zv✓ ll/7R�/7'OZ LA71ntt,t-1 (1a5 -(Ae- -CvIle'up/�7 <br /> rtaG/��I1S IF ff L E <br /> nn �/L ggyncrge Must /fie of /eas/ /o fid roti+ �eY'—o—lo <br /> late <br /> 0- � /h !! ! Fee Rec:✓�� �t� 9gr-yf a+ust ie q�e. ori �ea sf lD '�" mow`.,q � �.tus� 6 / walls 10 <br /> �9Q"ale-i � ZPIy7r,A ante rs,ice 9 mN /he- �a5f 51't� dof 1 `1.,f staff site visit: Initials of site visit staff- aj M e u u <br /> PERMIT APPROVED ZONING OFFICIAL: / ATE: �R� <br /> Re�OGaYri Si1�6 ct G.onfeNw�,i�y l Bcsu7'tO�Lto <br /> 3/ Z©/O 00 <br /> o <br /> Page 1 of 3 d Z <br /> Burnett County, WI Land Use Application-Rev 03/2017 -03 r----7 <br /> z <br /> m <br /> a <br /> m <br />