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LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> P 3 � <br /> a <br /> Applicant Complete All Sections Below This Line ' <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 < O <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 1 <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 <br /> Accessory Structure-Commercial(CI &II) $200 1 Addition to Accessory Structure-Commercial(CI &11) $200 0 <br /> Deck/Stairs/Patio/Retaining Wa1VSidewalklDriveway& Gazebo(WI Stat 59.692(lv)) $350 y <br /> m <br /> Campground Structures $125 Filling/Grading $150 <br /> m <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 <br /> 0 <br /> Permit Extension(Valid for one year-Only $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 application form,see corresponding application and fees. o <br /> *Items not luted above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> �• n <br /> Property Owner's Name: k LQ '. / � z <br /> Property Owner's Mailing Address: l ( ,SSVro o a '� <br /> 3l C�{41W'r��A& Q)L^ &�r �t State Zip d <br /> Property Site Address: , b �j 1 <br /> Contact's Telephone Number: -12L—U <br /> 0 <br /> Contact's Email: LA ezpew CpmCl S'� �T o <br /> y. <br /> Legal Description of Property: LCh P t <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional page if needed 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): � 1 <br /> Proposed Use of Structure/Addition: (-� rade _ <br /> Anticipated Start Date: Home/Cabin;Commercial Business;Bedroom;Deck;etc.) or <br /> m <br /> Building Contractor: Sewer Installer: y z <br /> N <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> �✓I Us�" rM� �� 1 5���- � i•�7�-�'wy' lo7L � <br /> � Fee Rec: <br /> Pic/ ��•(�( <br /> I �P�v1 <br /> r <br /> a <br /> m <br /> N <br /> O <br /> G Q C <br /> Date of staff site visit: D 2 Initials of site visit staff: p Z C <br /> .PERMIT APPROVED BY ZONING OFFICIAL: DATE: <br /> 0 <br /> Page 1 of 3 o Z <br /> Burnett County,WI Land Use Application—Rev 03/2017 <br /> 3 <br /> v <br /> x <br /> m <br /> A <br /> m <br />