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LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> Applicant Complete All Sections Below This Line 0' `r <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> a � <br /> Dwelling/Principal Building-Single Family J$200 <br /> Addition to Daelling/Principal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family Structural Alteration to Dwelling/Principal Buildings $200 m <br /> CommerciaVlndustrial Building Addition to Commercialllndustrial Building $200 I l <br /> Accessory Structtve(Non-Bunkhouse) Addition to Accessory Structure $150 <br /> n <br /> Bunkhouse Structural Alteration to Accessory Structure $150 °< <br /> Accessory Structure-Commercial(Cl &Il) Addition to Accessory Structure-Commercial(Cl&Il) $200Deck/Stays/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 m <br /> Cam ound Structures Pfa Filling Grading $150Camping Unit(Six Months Per Yeaz) Boathouse $500Permit Extension(Valid for one year-Only I Allowed <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 application form,see corresponding application and fees. c <br /> */terns not listed above will be treated as accessury structures,such as:pergolas,landscaping,etc. <br /> CA <br /> 0 <br /> Property Owner's Name: T, `z <br /> Property Owner's Mailing Address: 0 fh n 111N Ss33? a # <br /> City Sfate Zip <br /> d <br /> Property Site Address: 3�Ss5 M�/R,,e,1L Ly-t ��..In,v r, w i 51t Q 7tp <br /> Contact's Telephone Number: (0( Z- 4Vr1- 11480 c <br /> 5' <br /> do <br /> Contact's Email: fJ<S (vns,�:s1':u„,Q fannctit-/- .✓\ c� d <br /> N <br /> '1 <br /> Legal Description of Property: p <br /> Section#:J�Town#:—MOON Range#: h 15 W Town of: S "l►"({t�K) <br /> �) o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* I l <br /> Tax ID#(1-5 digit number;found on tax statement): (Proposed Use Use of Structure/Addition: 'Opic �� ) <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) a <br /> Building Contractor:_M�(Se�� Sewer Installer:—N z <br /> 7� <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERIMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Fee Rec: a0. ; <br /> N <br /> _y <br /> m <br /> z � Q <br /> 'J > z <br /> Date of staff site visit: ` / / Ini 'als of site visit staff: 'NOM r <br /> 0 <br /> z z r <br /> PERMIT APPROVED BY ZONING OFFICIAL �1 DATE / L C? � <br /> 000 s C <br /> Page 1 of 3 z <br /> Burnett County,WI Land Use Application—Rev 03/2017 <br /> x <br /> m <br /> m <br />