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LAND USE PERMITAPPLICATION — Burnett County, WI <br />ADDlicant 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 Struct ure(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 & I1) $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: G <br />Property Owner's Mailing <br />4/1-/l 6T <br />Property Site Address: 611,1/ G i <br />!g <br />City State Zip <br />Contact's Telephone Number: <br />Contact's Email: �� - / d/ L✓ t— L �- - k"–() <br />Legal Description of Property: -54,!!5 <br />Section #: Town #: N Range #: W Town of: /1'1 Z-,? 0 d Lt <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br />Tax ID # (1-5 digit number; found on tax statement): <br />Proposed Use of Structure/Addition: <br />Anticipated Start Date: nn <br />Building CotAractor: 0—M V * °l <br />(Home/Cabin; Commercial Business; Bedroom; Deck; etc) <br />Sewer Installer: <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />cr <br />c <br />Irl <br />0 <br />0 <br />b <br />m <br />S <br />N <br />0 <br />5� <br />1, <br />Gn <br />m <br />Date of staff site visit: Initials of site visit staff: 1 L <br />PERMIT APPROVED BY ZONING OFFICIAL: -kLDATE: SJ J ,– ��4 <br />i� <br />Page 1 of 3 <br />Burnett County, WI Land Use Application — Rev 03/2017 a <br />b <br />x <br />m <br />rr <br />c] � <br />� z <br />a <br />a <br />b <br />I <br />H <br />— f 1 <br />t <br />Z <br />Fee Rec:tboOD <br />