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LAND USE PERMIT APPLICATION — OLAH <br />Permit Types and Fees: (Check appropriate box/boxes) <br />Zm <br />IBJ M <br />Cn l3°u <br />-a <br />DatllinsTrincipal BuiWing- Sin* Family $3" <br />Addition to Dwdtiag' -.ipal &.1dmg- Sengk Family <br />S200 <br />Dvtetling/Prin4al Building- Multi -Family 5300 <br />Structural Alteration to DucilinWPrincipal Buildings <br />S200 <br />Commercial/Industrial Building 5300 <br />Addition to CommerciatAndustrial Building <br />5200 <br />Accessory Structure(Non-Bunkhouse) $150 <br />Addition to Accessory Structure <br />$150 <br />Bunkhouse $250 <br />Structural Alteration to Accessory Structure <br />$150 <br />Accessory Structure -Commercial (Cl & 11) $200 <br />Addition to Accessory Structure -Commercial (Cl & II) <br />$200 <br />Deck/Stairs/Patio/RetainingWall/Sidewalk/Driveway & <br />Campground Structures $125 <br />GaTebD (Wl Stat 59.692(l v)) <br />Filling/Grading <br />$350 <br />$150 <br />Camping Unit (Six Months Per Year) 5100 <br />Boathouse <br />$500 <br />Permit Extension (Valid for one Year - Only I Allowed) $100 <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: verizolas, landscavinuz etc. <br />Property Owner's <br />Property Owner's Mailing Address: <br />A- i <br />S—,') 7S Cv4a <br />City State Zip <br />Property Site Address: *,� 57 <br />!�. %S~C e k V 7`/ L, %vim 0,4 SPvory e4 w r' .5--�Yeg l <br />Contact's Telephone Number: 71!L $�D <br />Contact's Email: ry 7`44194/7 -el, e lV e <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. <br />Tax ID # (1-5 digit number; found on tax statement):_ ' �' £ g Q / _ <br />u <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: (Home/Cabin; Commercial Business; Bedroom; Deck, • etc.) <br />Building Contractor:. e L41Z k-14 1z pw1hC5, rAf4- Sewer Installer: <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />0__ A, r_ c - cam, ,; t`� �\'•� �-� <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 />Zm <br />IBJ M <br />Cn l3°u <br />-a <br />Z:4 <br />0 <br />00 <br />rel <br />N <br />` <br />U Y Y <br />