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LAND USE PERMIT APPLICATION — Burnett County, WI & r <br /> m- <br /> Ap licant Complete All Sections Below This Line 7' c v <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> d <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 g <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 O <br /> CommerciaUlndustrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> G1 <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 < <br /> Accessory Structure-Commercial(Cl &I1) $200 Addition to Accessory Structure-Commercial(Cl &11) $200 o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Drivemy& Gazebo(WI Stat 59.692(lv)) $350 w <br /> Campground Structures $125 Filling/Grading $150 <br /> m <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 <br /> ro <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 S, <br /> 0 <br /> *NOTE After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. <br /> *Communication Towers&Signs require a d; erent a lication orm,see rorres ondir;-a I;cation m;d ees. =7 <br /> gn 4 PP I P s PP f o <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> m n <br /> Property Owner's Name: z <br /> o � <br /> Property Owner's Mailing Address: /Q 0})ttt., G30 9 <br /> 6 <br /> ity Stat Zip o <br /> Property Site Address: 3o,3$Q g <br /> Contact's Telephone Number: <br /> 5' <br /> Contact's Email: ."r2 P� b <br /> Legal Description of Property:494,L& A L T Z{f 15 <br /> Section#: Town#: N Range#: W Town of: <br /> c <br /> *Attach additionalpage if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertypage.* 7 1 <br /> Tax ID#(1-5 digit number;found on tax statement): 215 7 <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) s <br /> n � <br /> Building Contractor: Sewer Installer: z <br /> H <br /> AREA BELOW TIIIS LINE RESERVED FOR ZONING STAFF C01%DAfEN:'S;CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO 1A^LL CONDITIONS (LISTED BELOW: <br /> �a�J 5\I s+,, -6 Ue I I ns�� l td` � � -ko <br /> Fee Rec:��C7 <br /> 0 <br /> m <br /> Date of staff site visit: Initials of site visit staff: ZR1 n <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: S -1 0 W <br /> V -ice <br /> m o ll nt7 <br /> Page 1 of 3 Z0 <br /> Burnett County,WI Land Use Application—Rev 03/2017 <br /> 3 <br /> v <br /> x <br /> m <br /> 7y <br /> m <br />