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LAND USE PERMIT APPLICATION — Burnett County, WI Cr <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Check appropriate box boxes) <br />o <br />Dwelling/Principal Building- Single Family 5300 Addition to Dwelling/Principal Building- Single Family $200 <br />7b <br />Dwelling/Principal Building- Multi -Family 5300 Addition to Dwelling/Principal Building- Multi -Family $200 <br />Q <br />Commercial/Industrial Building $300 Addition to Commercial/lndust rial Building $200 <br />I <br />Accessory Structure(Non-Bunkhouse) $15 Bunkhouse $250 <br />Addition to Acc. Structure $150 Addition to Accessory Structure -Commercial (Cl &11) $200 <br />r., <br />Accessory Structure -Commercial (Cl & 11) $200 Gazebo (W1 Stat 59.692(lv)) $350 <br />A <br />S <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway & Filling/Grading $150 <br />Campground Screen Porches $125 Boathouse $500 <br />771 <br />� <br />Camping Unit (Six Months/Year) $100 <br />Permit Extension (Valid for one year - Only I 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: D S V Iv G, Ictti Q_ S M Y <br />Property Owner's Mailing Address: a 17 3 lU L 1 (0 0 LtO C 6 s tE,- /0-T <br />- <br />C State Z <br />DbCilry � <br />Property Site Address:3 C) <br />_7`7x <br />Contact's Telephone Number: ((L J -6 % / <br />Contact's Email: /v\ t C) 0C_MJ 1L' lq"0 L, ` C, ®1,' ` <br />Legal Description of Property: Lm V Gsi' l I/� 3 l '1/u C_ 6 1-- QjQo <br />Section #: 20 Town #:_ l d N Range #:��W Town of: Q <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attachtaxsystem propertypage. <br />Tax ID # (1-5 digit number; found on tax statement): J <br />Proposed Use of Structure/Addition: aLe t. "/ 4 lis <br />Anticipated Start Date: (Home/Cabin, Commercial Business; Bedroom; Deck; etc.) <br />Building Contractor: Sewer Installer: <br />AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br />IS PERMIT IS SUBJECT TO ALL CONDITIONS LIST D BELOW: <br />O �i�Im a� a ow 1l v� -I-�,',S S rVA-U rt, <br />N <br />Date of staff site visit: S 3 6 I& Initials of site visit staff: <br />S 3o-j�7 <br />PERMIT APPROVED BY ZONING OFFICIAL: DATE: <br />Page 1 of 3 <br />Burnett County,I Land Use Application – Rev 10/2016 <br />A <br />ft <br />0 <br />r <br />0 <br />a <br />CD <br />CD <br />W d <br />G <br />N <br />O� <br />o <br />� <br />7b <br />y <br />Q <br />I <br />r., <br />� <br />A <br />S <br />� <br />771 <br />� <br />z <br />N <br />N <br />Fee <br />Rec: <br />c* 11 2-5-15-111 <br />