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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 />' <br />Davlling'Principal Building- Single Family $300 Addition to DwElling'Pnncipal Building- Single Familj <br />a0 <br />D,mlling!Principal Building- %lulti-Family $300 Addition to Dwelling -Principal Building- Multi -Family <br />$200 <br />Commercial/industrial Building $300 Addition to Commercial%Industrial Building <br />5200 <br />Accessory Structure(Non-Bunkhouse) $150 Bunkhouse <br />$250 <br />$150 Addition to Accessory Structure -Commercial (Cl & 11) <br />S200 <br />Addition to Acc. Stricture <br />Accessory Structtue-Commercial (C1 & 11) S200 Gazebo (Wl Stat 59.692(lv)) <br />$350 <br />Filling/Grading <br />$150 <br />DeckrStairsPatio Retaining Wall, 9dewalkiDriveway & <br />S500 <br />Campground Screen Porches i 1/� + Boathouse <br />Camping Unit (Six Months Year) $100 <br />Permit 1?."tension (Valid for one year - Only 1 All) d) 5100 <br />*NOTE: After -the -fact (when no permit is obtained prior to construction) is up to three times the normal fee. <br />`Communication Toivers & Signs require a different application form, see corresponding application and fees. <br />*Items not listed above will be treated as accessorj, structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: 1 ' <br />Property Owner's Mailing Address: /0701 <br />Property Site Address: of 77 <br />a2 Sry+Lk LALe <br />Cit) <br />Zip <br />Contact's Telephone Number: <br />Contact's Email: %''/ rlr A <br />I.egal Description of Property: �.Cr1 i Chiµ-t1aV' 7—Yo Qv.- L,+ I S 25"TjQ"(' <br />Town #: 4/0 N Range #: IS NV Town of: J k�l..sa <br />Section �.•._- <br />#: o� <br />' ,-lttach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax s),stem property page.' <br />Tax ID # (1-5 digit number; found on tax statement): 157(-,77157(-,77 <br />c <br />Proposed Ilse of Structure/Addition: , <br />Anticipated Start Date: _/ <br />(Home.Cabin; Commercial Business; Bedroom; Fleck; etc.) <br />Sewer Installer: �Sy2 K%14 01 t"'`' <br />Building Contractor:f_nA/ut/Yt-- <br />AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br />\/A TS - )-)-°� <br />Date of staff site visit: Initials of site visit staff: <br />PERMIT APPROVED BY ZONING OFFICIAL: - <br />Page 1 of 3 <br />Burnett County, WI Land Use Application — Rev 02/2017 <br />