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LAND USE PERMIT APPLICATION —Burnett County, WI r <br /> a <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Check appropriate box boxes) ~f e P <br /> d <br /> Dwelling/Principal Building-Single Family $300 I Addition to Dwelling/Principal Building-Single Family $200 <br /> DwellinglPrincipal Building-Multi-Family $300 Addition to Dwclling/Principal Building-Multi-Family $200 <br /> a <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 � <br /> ti <br /> Accessory Structure(Non-Bunkhouse) 150 Bunkhouse $250 <br /> C) <br /> Addition to Acc.Structure $150 Addition to Accessory Structure-Commercial(Cl&Il) $200 4 <br /> Accessory Structure-Commercial(CI&11) $200 Gazebo(WI Stat 59.692(1 v)) $350 0 <br /> Deck/StairstPatio/Retaining Wall/Sidewalk/Driveway& Filling/Grading $150 w <br /> Campgrormd Screen Porches $125 Boathouse $500 <br /> E <br /> Camping Unit(Six Months/Year) $100 1 •-+ <br /> r. <br /> Permit Extension(Valid for one year-Only 1 Allowed) 5100 I <br /> Z <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. <br /> 1 <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Uj <br /> Property Owner's Name: V fn# (a4AT 1 b <br /> Z <br /> N <br /> Property Owner's Mailing Address: -7910 C-r4 Kd K 8D)e ID) 5/1"e W.T- SYS-7-2a <br /> City State Zip rj <br /> Property Site Address: 77Llg Cen4e� S1 �anlur4 IN; SLIC3 0 <br /> S—3 <br /> Contact's Telephone Number: 1 399 - 2-2 91— -r-7 0 <br /> rhheeFs v,^ne foal orq vt^ 0 <br /> Contact's Email: 1 S C&A 10 rt @ U/rr1tTCOiJn`�h• +� 3 <br /> ac t <br /> peetS is%Adc) Darty Ab7+r 3 4hl-v lo;nel b/k r o 0 <br /> Legal Description of Property: a. <br /> w <br /> Section#: 2 19, Town#: LLI_N Range#: I b W Town of. S w t <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): Z 3O,Z l 1 <br /> Proposed Use of Structure/Addition: SA t-r S s oa A&C- I�Z, <br /> Anticipated Start Date: j�PIz t l Z91 (Home/Cabin;Cannuercial Business;Bedroom;Deck,etc) r— <br /> r <br /> Building Contractor: S 11EVC rt/(�{i{ BoI�tl�Nbf Sewer Installer: P I-A- z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY — <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW) : <br /> a Fe�keRec: <br /> J <br /> e. 5 i o.,1 (1 <br /> Cd] wed, <br /> c <br /> M <br /> Z m <br /> Date of staff site visit: Initials of site visit staff: S1� IV M W <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE. N <br /> G)O o <br /> Page 1 of 3 <br /> Burnett County, WI Land Use Application—Rev 1/2017 Z <br /> G�7 <br />