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LAND USE PERMIT APPLICATION — Burnett County, WI <br />Annlicant Complete All Sections Below This Line <br />Permit Types and Fees: (Check appropriate box boxes) <br />Dwelling/Principal Building - Single Family <br />$300 <br />Addition to Dwelling/Principal Building - Single Family $200 <br />Dwelling/Principal Building - Multi -Family <br />$300 <br />Structural Alteration to Dwelling/Principal Buildings $200 <br />Commercial/Industrial Building <br />$300 <br />Addition to Commercial/Industrial Building $200 <br />Accessory Structure(Non-Bunkhouse) <br />$150 <br />Addition to Accessory Structure $150 <br />Bunkhouse <br />$250 <br />Structural Alteration to Accessory Structure $150 <br />Accessory Structure -Commercial (Cl & 11) <br />$200 <br />Addition to Accessory Structure -Commercial (Cl & 11) $200 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway & <br />Campground Structures <br />$125 <br />Gazebo (WI Stat 59.692(lv)) $350 <br />Filling/Grading $150 <br />Camping Unit (Six Months Per Year) <br />$100 <br />Boathouse $500 <br />Permit Extension (Valid for one year - Only 1 Allowed) <br />$100 <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. <br />*Items not listed above will be treated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: A Ilia <br />0 <br />0 <br />c <br />5 <br />Property Owner's Mailing Address: /V'609Sfi. Iii 7 S; ,_,. UJI 5NA'72— <br />City State Zip <br />Property Site Address:—z, 3 6 z- Floyd l�G.j�r- �r;vL S;�-.� LVX_ S141670_ - <br />Contact's Telephone Number: / Zlo2$7 '322L) N <br />0 <br />5' <br />ac <br />Contact's Email: /ri;Kc Jt►cvr� g�Iwwia� /.[t, d <br />Legal Description of Property: <br />Section #: Town #: N Range #: W Town of: <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. * I F\ <br />Tax ID # (1-5 digit number; found on tax statement): Z? -0Z_ <br />Proposed Use of Structure/Addition: Ho -r, <br />Anticipated Start Date: Sep • Z-!5'- (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: 6 r,2 A, 2 e rse Sewer Installer: Wad c_ ���s�a►.. <br />AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />Date of staff site visit: Initials of site visit staff: <br />PERMIT APPROVED BY ZONING OFFICIAL:" DATE: ' <br />Page 1 of 3 <br />Burnett County, WI Land Use Application — Rev 03/2017 <br />r <br />x <br />Fee Rec:L d dJ D <br />