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LAND USE PERMIT APPLICATION— Burnett Countv. WI a b <br /> Applicant Complete All Sections Below This Line 0' <br /> a <br /> '1 <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> Dwelling(Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 v a <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling(Principal Buildings $200 O <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 1 <br /> AccessoryStructure Non-Bunkhouse <br /> ( ) $150 Addition to Accessory Structure $150 � (y <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 <br /> Accessory Structure-Commercial(CI&11) $200 1 Addition to Accessory Structure-Commercial(CI &11) $200 V 1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 Ln JJ <br /> Campground Structures 7 <br /> Cam D <br /> PEa $125 Filling/Grading $150 V <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 'Z <br /> m <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 5 0 SQ� <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal tee. <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. 1 1 <br /> w v <br /> Property Owner's Name: C� Q u Le V�— <br /> o # <br /> Property Owner's Mailing Address: Q Ji` /(/ !1 r i t7'/6I4/ ** ) p <br /> A City State Zip o J <br /> Property Site Address: Z 5�h/ C g d 5S(C3 E 0 <br /> Contact's Telephone Number: <br /> Contact's Email: (— �vt <br /> Legal Description of Property: vt,z) :5ac.0 5 C(5 py(� /�[w!� z- �O <br /> Section#: Town#: N Range#: W Town of: 5 ,� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* a S <br /> Tax ID#(1-5 digit number;found on tax statement): a <br /> / � W <br /> Proposed Use o jck�n�. L U � — L 6 — 3 0_3 y C&'r G <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Debk etc.) <br /> A p. <br /> Building Contractor: Sewer Installer: � z <br /> y <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDTFIONS ONLY _. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: -� t <br /> D <br /> Fee Rec: <br /> �i <br /> 0 <br /> N ice+T <br /> ° NZ �^ <br /> Date of staff site visit: Ini 'als of site visit staff: z' U <br /> � Z� t <br /> o _ � <br /> �] r Z C7 <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: L / *< i7® <br /> o <br /> Page 1 of 3 0 <br /> Burnett County,WI Land Use Application-Rev 03/2017 <br /> x <br /> m <br /> A <br /> m <br />