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I <br />LAND USE PERMIT APPLICATION — Burnett Countv, WI <br />Annlicant Comnlete. All CPction, Relow Thi, Tine <br />Permit Types and Fees: (Check appropriate box/boxes) <br />welling/Principal Building - Single Family <br />$300 <br />Addition to Dwelling/Principal Building - Single Family $200 <br />Dwelling/Principal Building - Multi -Family <br />$300 <br />Structural Alteration to Dwelling Principal Buildings $200 <br />Commercial/Industrial Building <br />$300 <br />Addition to Commercial/Industrial Building $200 <br />Accessory Structure(Non-Bunkhouse) <br />$150 <br />Addition to Accessory Structure $150 <br />Bunkhouse <br />$250 <br />Structural Alteration to Accessory Structure $150 <br />Accessory Structure -Commercial (C1 & 11) <br />$200 <br />Addition to Accessory Structure -Commercial (C1 & I1) $200 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway & <br />Campground Structures <br />$125 <br />Gazebo (WI Stat 59.692(lv)) $350 <br />Filling/Grading $150 <br />Camping Unit (Six Months Per Year) <br />$100 <br />Boathouse $500 <br />Permit Extension (Valid for one year - Only 1 Allowed) <br />$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: T, <br />�[ %@ � <br />Gx L e5Gryt <br />Property Owner's Mailing Address: <br />7 �� Ce a "/ C4 <br />( Au, S <br />`V G. J r"q,- %4W ��G? <br />Property Site Address: � � <br />ff `` I_ ti <br />`-tom k <br />Anh <br />City State Zip <br />Contact's Telephone Number: ��; <br />f z -- ? <br />1 C) 9�v <br />Contact's Email: & lJ 4610 <br />SO W i A�_ <br />S4 b t. L <br />4 CI Wl "1 <br />Legal Description of Property: () T C S I V :'a S P� OCIU <br />Section #:_ Town #: N Range #: `J W Town of - <br />F0 ue ffQ <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): 4M 2 <br />Proposed Use of Structure/Addition: Ll L -y-, a 4�:rYtl <br />Anticipated Start Date: if — / (Home/Cabin; Commercial Business: Bedroom'ck; 'r) <br />Building Contractor: Cf_ -FS CC1LlL� 1 �(Oy7 Sewer Installer: 4 (1 I . <br />AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br />S��T �eV�ce� �O v� I�S�(1.6Je�✓` 6Y-) Gr'ej I <br />Date of staff site visit: 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 />2 <br />9 <br />N <br />0 <br />r <br />0 <br />Fee Rec:3 Oy <br />N <br />UuU <br />nZ <br />co o <br />rV <br />0 <br />co <br />