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LAND USE PERMIT APPLICATION — Burnett County, WI <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Check appropriate box/boxes) <br />Dwelling/Principal Building - Single Family 113001 <br />Addition to Dwelling/Principal Building - Single Family <br />$200 <br />Dwelling/Principal Building - Multi -Family 300 <br />Structural Alteration to DwellingTrincipal Buildings <br />$200 <br />CommerciallIndustrial Building $300 <br />Addition to Commercial/Industrial Building <br />$200 <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 & I1) $200 <br />Addition to Accessory Structure -Commercial (CI & 11) <br />$200 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway & <br />Campground Structures $125 <br />Gazebo (WI Stat 59.692(tv)) <br />Filling/Grading <br />$350 <br />$150 <br />Camping Unit (Six Months Per Year) $100 <br />Boathouse <br />$500 <br />Permit Extension (Valid for one year - Only I Allowed) $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: Avm 1 `yo lvia'e <br />Property Owner's Mailing Address: <br />(o�D IUN��3v <br />_ l (P 2S J/Qkt i e,, S 1 D �J1V, \(\j rfState Zip <br />Property Site Address: <br />Contact's Telephone Number: (S ( -5 S-) - I b <br />Contact's Email: AK (- 10 as dw' tC+��'. Ne - <br />Legal Description of Property: <br />Section #:_ Town #: N Range #: <br />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): Y �C <br />Proposed Use of Structures//Addition: C �( /J <br />Anticipated Start Date: l'-# - 17 (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: � �W�(m-t/� Sewer Installer: C -)A k, <br />AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />'In"el 41- �Z/,w tv *- >- 1s.p�, <br />Date of staff site visit: -S-30 ' % 7 t'tiaof tePERMIT APPROVED BY ZONING OFFICIAL:..�i�-- DATE: <br />Page 1 of 3 <br />Burnett County, WI Land Use Application — Rev 03/2017 <br />N <br />0 <br />5' <br />vq <br />b <br />n <br />ro <br />FY <br />Fee Rec -m <br />W <br />NZ c <br />Z <br />�0 <br />