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LAND USE PERMIT APPLICA'T'ION—Burnett CountYzD <br /> Permit Types and Fees:(Check appropriateboxtboxes) m <br /> Addition to DwelnyrPrincipal Building-Sog1e family $200 1 l <br /> Dwet{'mglpnneipal Building-Stngle Film li <br /> ily 5300 � t <br /> Dwelhng/Prineipal Building-Milti-Fatuity, $300 Structural Alteration to 1?weNng'Principal$uiidings $200 , O <br /> 5300 Addition to CommerciaViridustrial Building 5200 I n <br /> Commercial(tndus[dal BuSlmng ' � <br /> $150 <br /> Accessory Sir,,ture(Non-Buakhotue) St50 Addition to Accessory Strixttae . <br /> 5250 Structural Alteration to Accessory structure <br /> Btaokhotr>e <br /> 5150 <br /> I(fl $200 I o <br /> Accessory Struct�e-Commercial(Cl&I I) $200 Addition to Accessory Structure-Cammercla &I1') <br /> I <br /> Gazebo(WI&at 59.6920 v)) $350 r <br /> DeckrStairsi?atiorRctaining Wall'Sidewalk/Dnvcway&. St50 ti <br /> Campground Structures 5125 FiliinglCaadri <br /> $500 ro <br /> Camp utg Unit(Six Months Per Year) 5100 Bvathome -_ <br /> r <br /> Permit Extension(Vatidfor one year-only 1 Ailowed) $100 a <br /> Z <br /> 0 <br /> "NOTE:After-the-fact(whet/no permit is obtained prior to <br /> construction}is up to three times the normal fee. o <br /> *Communication Towers&Signs require a different application form,.see corresponding application and fees. o <br /> c <br /> "frcmts not listed above will be treated as accessar strucntres.such as: er otos,tan sea to ,etc. � <br /> r: <br /> ((�� ��rr <br /> i '��i.f K-!i'1Z tGr to F4'lfff� <br /> Property Owner's Name: <br /> Property Owner's Mailing Address: Cloy State Zip I o1 <br /> Property Site Address: f i t t ti t w <br /> Contact's Telephone Number:_ <br /> r •�•_f C1�I� �t� �f i�t"l'CL:I 1 o Ct/',.tf� t7 �—` <br /> Contact's Email: 01 f C 5 Irr r r if <br /> s t <br /> Legal Description of Property. n l <br /> Section#:_� Town#:__ _N Range#: _W Town of:_ [y � ---.-- <br /> *A/tach additional page if needed for lengthy description OR attach/a copy of the deed OR arrack tax-system prnper tyPage' <br /> Tax ID#(1-5 digit number;found on tax statement): ��vl�� 1✓ � � 1� <br /> Proposed Use of Sttuctlue/Addition: gra tn/ t� — tK I1 <br /> Anticipated Start 1?ate: • "� 'f` (Ho metCahin; ommercial Rrrsiness;Bedroom:heck;etc) <br /> Building Contractor Lid Lara t Sewer Installer O <br /> z <br /> VIC <br /> ov <br /> > 1� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: f <br /> ��S� Cb�� Fee Rec: e-00 <br /> J N Q s v <br /> �e( ��� I <br /> 9, 3 o_ <br /> � c <br /> S3 z <br /> D <br /> Date of staff site visit: � Initials of site visit aff: ^ M e� <br /> PEM <br /> RIT APPROVED BY ZONING OFFICIA DATE4—JS-� / ~ <br /> o = <br /> Page 1 of 3 '� <br /> C <br /> Burnett County,WI Land Use Application—Rev 03/2017 <br /> �r <br />