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LAND USE PERAHT APPLICATION — Burnett County, W1 <br />Permit Types and Fees: (Check apprnpriate boxthexes) <br />D-11 ngTrineipal Building- Single Family <br />S300: <br />}< Addition to Dwelling/Principal Building- Single Family <br />S200 <br />Daelting/Prineipal Building - Multi -Family <br />$300 <br />Struct sal Alteration to DvvellingJPrincipal Bmldinp <br />$200 <br />CommetciaUludmtrial Building <br />$300 <br />Addition to Commercial/Industrial Building <br />$200 <br />Accessory Structure(Non-Bunkhouse) <br />$150 <br />Addition to Accessory Structure <br />$150 <br />Bunkhouse <br />$250 <br />Structural Alteration to Accessory Structure <br />$150 <br />Accessory Structure -Commercial (Cl & I1) <br />$200 <br />Addition to Accessory Stricture -Commercial (Cl & 11) <br />$200 <br />Deek/Stsirs/Patio/Retainiag Wall/Sidevudlk/Drivevcay & <br />CampgroimdStructures <br />$125' <br />Gazebo (WI Stat 59.692(lv)) <br />$350 <br />Fflling1Q-.ding <br />$150 <br />Camping Unit (Six Months Per Year) <br />$100 <br />Boathouse <br />$500 <br />Permit Extension (Wiid for one year - Only I Allovied) <br />$100 <br />1 <br />*NOTE: After-the-W (when no permit is obtained prior to construction) is up to three times the normal fee. <br />*Comm—ation Towers & Signs require a different qt pliaation form, see correspondbig application mul fees. <br />Property Owner's Name: i k t cL mt( 4- U C7'n A 4 ?e-� e <br />Property Owner's Mailing Address: 13 )0 O TA I ((�f ! r.- o <br />Property Site Address: q a (S �V wl ( c l 4 tl -e- ty t, Sc P_ � <br />Contact's Telephone Number. <br />Contact's Email: 1M 1 K <br />T+eo>s1 �1 <br />State Zip <br />Legal Description of Property: 5-e,e- cy 2 <br />Section #: 2.3 Town #: `to :,N Range #: 15- W Town of: <br />*Attach additional page ifneeded for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br />Tax ID # (1-5 digit number, found on tax statement): <br />Proposed Use of Structure_ /Addi n: ��� �„t .,,� �,z U S e-- <br />Anticipated Start Date:. (Rome/Cabm; Commercial Business, Bedroom; Deck, etc.) <br />Building Contractor:cer-�Pt, r e..s Sewer Installer: <br />SUBJECT TO ALL <br />/�4% Surma s ac s v i e. S¢h' '74ry Uri- °-4 <br />y�v�Jlvst /-AQ— /t'�� <br />P o M -a4�1 <br />Date of staff site visit: y/Z ��� c% Initials of site visit staff: � <br />PERMIT APPROVED BY ZONING OFFICIAL: DATE: /ram <br />Pagel of3 <br />Burnett County, WI Land Use Application — Rev 03/2017 <br />a <br />r <br />� <br />o- <br />A <br />�y <br />�O <br />�R <br />0 <br />r <br />�a <br />ro <br />z <br />c <br />CD <br />d <br />o <br />00 <br />agro <br />` <br />fi <br />z <br />9 <br />z <br />x <br />� <br />Fee Rec: Zoo, <br />N <br />N <br />O <br />to <br />