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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 $300 <br />Addition to Dwelling/Principal Building - Single Family <br />$200 <br />Dwelling/Principal Building - Multi -Family $300 <br />Structural Alteration to Dwelling/Principal Buildings <br />$200 <br />Commercial/industrial Building $300 <br />Addition to CommerciallIndustrial 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 (Cl & I1) <br />$200 <br />Deck/Stairs/Patio/Retaining Wall/Sidevalk/Drivewuy & <br />Campground Structures 1$125 1 <br />Gazebo (WI Stat 59.692(lv)) <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 1 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: �& gypA9 (iE C -4K l 0i L— -VV 61— <br />Property Owner's Mailing Address: 0 a/ � � I JZA0 f:, C 0 {ZCyi` AtA MM ��T-7 / <br />City State Zip <br />Property Site Address:iP rrp ►� I rZGI-i 1,54" LAtetr-1—kAl1- , OA-i,440r2y LA)T- 4 gd?30 <br />Contact's Telephone Number: <br />Contact's Email: 17e - eC - `15 , Co W) <br />Legal Description of Property: e�- V f k -TTA M 44'D <br />Section #: 19 Town #: 44D N N Range #: /11 W Town o£ SC OTT - <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): 18? 1(to <br />Proposed Use of Structure/Addition: STO tZ A,4 e IR, L) i Lo 1 tv <br />Anticipated Start Date: 101 - — �'� (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: qOU fL U 1 t -00A -j 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 />L r J� 1e <br />'►V, k/1� I� <br />NO '�� <br />Date of staff site visit: I J C-)" 1 ' I 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 />N <br />5' <br />c� <br />d <br />�'0 <br />c <br />a <br />�1 <br />Fee Rec:_ e <br />x <br />e <br />rn <br />N <br />O <br />z <br />z <br />a � <br />z <br />VA <br />Z <br />z "- <br />0 <br />iF <br />C= <br />O <br />