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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> �. <br /> Applicant Complete All Sections Below This Line 0' `+ <br /> 9 71 <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 /> DwellingTrincipal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 O <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 m <br /> Accessory Structire(Non-Bunkhouse) $150 Addition to Accessory Structure $150 (� <br /> 9 1 C) 'l <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 < <br /> Accessory Structure-Commercial(Cl &I1) $200 Addition to Accessory Structure-Commercial(Cl &11) $200 c <br /> Deck/Stairs/Patio/Retaining WaIVSidewalk/Driveway& Gazebo(WI Stat 59.692(Iv)) $350 <br /> Campground Structures $125 1 Filling/Grading $150 gg• <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 �y <br /> m <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 5, <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 /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. fl <br /> Property Owner's Name: ;:S704) to �rt k 7 O <br /> C `� <br /> Property Owner's Mailing Address: 7-1 b Ye-llowLKO weks a <br /> _ _ 1 <br /> City State Zip to <br /> Property Site Address: S 1V� C S {4 OV � CC//--'' <br /> Contact's Telephone Number: 13'R Wt)?C 1 C rL5 DUI.. I -�] j -Z9 3 S o 1 <br /> av <br /> Contact's Email:_ b C9 J-P ef't t (S O k) M& M A 1 rf (p M <br /> Legal Description of Property: L O T 3 `J t)tuty r1'114p 3A A l) I b P Z7 <br /> Section#: Town#: CZN Range#: W Town of. U IU 10 U <br /> H <br /> *Attach additionalpage if needed for lengthy description OR attach aycopy of the deed OR attach tax system property page.* } 5 ) <br /> Tax ID#(1-5 digit number; found on tax statement): Z�a/3 y <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: 3111,2E Z Q 1 7 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> _ _ <br /> Building.Contractor: �C TeZS(�k���S (� Sewer Installer: IV d vo C <br /> in 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 /> Fee Rec:u()i <br /> y <br /> N <br /> OD <br /> 0 <br /> Z <br /> Date of staff site visit: InRials of sit visit staff: M z <br /> 1 <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: —I -Z® o <br /> N <br /> Page 1 of 3 2 <br /> Burnett County,WI Land Use Application—Rev 03/2017 <br /> 3 <br /> a <br /> s <br /> m <br /> a <br /> m <br />