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LAND USE PERMIT APPLICATION - Burnett County, WI b <br /> a <br /> Applicant Complete All Sections Below This Line 0 9 v <br /> Permit Types and Fees:(Check appropriate box/boxes) n' <br /> DwellinWPrincipal Building-Single Family $300 1 Addition to Dwelling/Principal Building-Single Family $200 \ <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 T, <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 „1 <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> n <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 ° _ <br /> Accessory Structure-Commercial(Cl &11) $200 Addition to Accessory Structure-Commercial(Cl & 11) $200 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 rn <br /> Campground Structures $125 Filling/Grading $150 <br /> 12 V <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 'v ul <br /> m <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 S, <br /> z <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. ° <br /> *Communication Towers&Signs require a different aPPlicationrorm,see corresponding application and ees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. a <br /> ✓' 11 �• run <br /> Property Owner's Name: <br /> / <br /> Property Owner's Mailing Address: �5v� AM-e' <br /> -76� Rel Z 9 <br /> / 7 C• y State Zip v <br /> Property Site Address: 65o 2 )' , 2y'a zd LAA0,4y, Lim- s,VY93 <br /> Contact's Telephone Number: 3-7/. O t a cS: i; <br /> 7 <br /> Contact's Email: 'G r,$Ort 44 I C2(C t sr, o <br /> n <br /> Legal Description of Property: W!/Z ;!E�E Alin/ FX PRT L.Ya 4E cl_,!� Clom loam R17 <br /> � p y <br /> Section#: < Town#: 3 i N Range#:_j_t9_W Town o£ /77e e//l) ,r7 a <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* /1 <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> n <br /> Building Contractor: w ca _T a n e,r_n Sewer Installer: N <br /> Ty � z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Fee Rea co <br /> x <br /> `o <br /> m <br /> N <br /> O <br /> Date of staff site visit: Initials of site visit staff: > Z n <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE.— ,p P.pir-9 <br /> Page 1 of 3 o Z (f1! <br /> Burnett County, WI Land Use Application—Rev 03/2017 <br /> m <br /> M <br /> M <br />