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LAND USE PERMIT APPLICATION — Burnett County, WI <br />Annlicant Comnlete 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 />1 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 />$10011 <br />Boathouse $500 <br />Permit Extension (Valid for one year - Only 1 Allowed) <br />$100 11 <br />1 <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: Rokx <br />Property Owner's Mailing Address: �' V s /.J ©%`( <br />Property Site Address:` , VJ �•I OW /1 0111 �-f�'( oI I 1 <br />Contact's Telephone Number: (oj d —JV I-- <br />Contact's Email: / / AW <br />Legal Description of Property: <br />H-e-SO4T3i <br />lzl5 w) Otmt1T� kve' J- l's <br />A <br />Section #: Town #: N Range #: W Town of: Ll I � I e+k CON) <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): 1 Od,�y <br />Proposed Use of Structure/Addition: Sr l6& <br />Anticipated Start Date: j _ f ' 9 (`Home/Cabin; Commercial Business, Bedroom; Deck; etc.) <br />�t7�1 <br />Building Contractor: Z_V WA W f�j �; �.V Sewer Installer: <br />AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />X013 1�2o <br />7, <br />/' X <br />Date of staff site visit:_9 z Z-// ! Initials of site visit staff: j <br />PERMIT APPROVED BY ZONING OFFICIAL: DATE: Zi <br />Page 1 of 3 <br />Burnett County, WI Land Use Application — Rev 03/2017 <br />i< <br />0 <br />e <br />0 <br />0 <br />C <br />0 <br />a <br />su <br />5 <br />Fee Rec: `5Z0C(:) <br />x <br />GC= <br />� <br />ZC <br />Mz <br />oo <br />Z <br />d <br />a <br />ro <br />x <br />PO <br />PO <br />m <br />