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LAND USE PERNIIT APPLICATION - Burnett County, WI <br /> Applicant Complete All Sections Below This Line 0' <br /> ON <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 Addition to Dwelling/Principal Building-Multi-Family $200 O <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 1 <br /> Accessory Structure(Non-Bunkhouse) $150 Bunkhouse $250 <br /> Addition to Ace.Structure $150 Addition to Accessory Structure-Commercial(Cl &11) $200 <br /> Accessory Structure-Commercial(Cl &Il) $200 Gazebo(WI Stat 59.692(lv)) $350 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Drivewuy& Filling/Grading $150 w <br /> Campground Screen Porches $125 Boathouse $500 <br /> Camping Unit(Six Months/Year) $100 <br /> n <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. 0i <br /> *Communicalion Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> n <br /> rn .9 <br /> Property Owner's Name: mgttA•S -e^ o y <br /> asi2a a � <br /> Property Owner's Mailing Address: Z 4 4 W S'V%30 � <br /> Property Site Address: o2Lla/.� 6/t!Z;C, 1C d �bcw I.l� <br /> y X Ci�tyy$3O State Zip <br /> p <br /> Contact's Telephone Number: <br /> Contact's EmailWet-'ti i S oa. MA: I <br /> _ d <br /> Legal Description of Property: 0 Y2 5 NW CX N <br /> Section#: 509 Town#: Tr/O N Range#: /V W Town of Scof'Ar' y <br /> t\ o <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system property page.* 1 w <br /> SU <br /> Tax ID#(1-5 digit number;found on tax statement): /76R7 <br /> Proposed Use of Structure/Addition: AlfOMe 5 <br /> Anticipated Start Date: /i/Wise (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Oy : <br /> Building Contractor: tt/i(I �OA g�✓r�!. Sewer Installer: EX i�����v �-' z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> T` IS PERM T IS SUBJECT TO ALL CONDITIONS LIST D BELOW: <br /> Fee Rec:gzlf <br /> Cr---�-_ <br /> M <br /> CD <br /> N.m <br /> Date of staff site visit: Ini ' Is of s' visit staff., 4 i ! <br /> PIPT <br /> J // 6 eo <br /> PERMIT APPROVED BY ZONING OFFICIAL: tet' DATE: I / E, O C <br /> Li Z <br /> Page 1 3 <br /> Burnett County, W1 Land Use Application—Rev 10//2016 <br />