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rA <br />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 />1$250 <br />lAddition to Commercial/Industrial Building <br />$200 <br />Accessory Structure(Non-Bunkhouse) $150 <br />Addition to Accessory Structure <br />$150 <br />Bunkhouse <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/Sidewalk/Driveway & <br />Campground Structures $125 <br />Gazebo (WI Stat 59.692(lv)) <br />$350 <br />Filling/Grading <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 11 <br />1 <br />*NOTE. After-ihe-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: <br />Property Owner's Mailing Address: <br />5RC)fl' <br />City SState <br />Zip <br />S(A)TProperh Site Address: 4 3 <br />Contact's Telephone Number: 6s t 2 y % �7i y� <br />Contact's Email: y Y1 % L{ C, /V 4t !/ ( C-0e),L ` r !/ <br />Legal Description of Property: S L 1� Arlt m k 2c) 40VN" V t I * 1 0"pl <br />Section #: Town #:_ Range #:__I 45__W Town of: -kc- .Sb-\ <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): <br />Proposed Use of Structure/Additio I / F f -K <br />Anticipated Start Date: %)?,CAvy. Zo (`7 (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: 5V0 +- 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 />�GLk 5h�1I 6e- 7 10` A-0 S'Alob 1 <br />3 0I <br />,��er�1/ 1 � Y�2 . •� <br />Date of staff site visit- <br />Init• is of site visit staff - <br />3Y ZONING OFFICIAL: JIVA--DATE: <br />L11 <br />Page 1 of 3 <br />Burnett County, WI Land Use Application — Rev 03/2017 <br />V\ <br />.i- <br />b <br />r— <br />d <br />WE <br />0 <br />n <br />C4 <br />o <br />Y � <br />0 <br />0 <br />z <br />0 <br />Fee Rec: /c.- S, -- <br />bD <br />z m � <br />N m c7 C <br />E 0 ca <br />0O N <br />Qz::•� <br />