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LAND USE PERMIT APPLICATION—Burnett County,WI b <br /> s. K <br /> Applicant Complete All Sections Below This Line a <br /> Permit Types and Fees:(Check appropriate boxlboxes) ) <br /> d T' <br /> Dwelling/Principal Building-Single Family $300 11 JAMti,,to Dwelling/Principal Building-Single Family $200 <br /> Dvclling/Principal Building-Multi-Family $300 Slna;tural Alteration to Dwel ing/Principal Buildings $200 <br /> I <br /> CommercialAndustrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> I I <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 <br /> Accessory Structure-Commercial(Cl&Il) $200 Addition to Accessory StructuraCommercial(Cl&II) $200 <br /> UccIU'StsirsTatiolRetaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 � d <br /> Campground Structures $125 1 Filling/Caading $150 <br /> pi <br /> Camping Unit(Six Months Per Year) $100Boathouse $500 <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 <br /> VU <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. <br /> „ 1 J <br /> "Communication Towers&Signs require a dijjerent applivation form,see corresponding application and jeer. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landsca ing,etc ' <br /> w f] <br /> Property Owner's Name: (>L't A !S QlX\A 'Kt1 Ck 0 Erarn <br /> ii SJr`Il$ o x <br /> Property Owner's Mailing Address:_ i'1 C. Itilf 11dD 7 c Q <br /> City state zip <br /> Property Site Address: l u n w Q 6-=s Y(�-15 cin C( 1 <br /> Contact's Telephone Number: <br /> Contact's Email: . H�a�ce- I ��ht)TmQ i <br /> m <br /> Legal Description of Property: a <br /> Section#: _Town#:_4D—N Range#: q—W Town of: �� f T T) r s <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> L <br /> o <br /> 1 <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> Proposed Use of Structure/Addition: t )a QQ p <br /> Anticipated Start Date: �—(Home/Cabin;Commercial Business;Bedroom;Deck;etc.) O t �j <br /> :i'11 t l 8RC <br /> Building Contractor: (�. ��� r���lur iL�f\ Sewer Installer: ��}� z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY � V� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Fee Rec: <br /> w <br /> m <br /> z <br /> z <br /> Date of staff site visit: _ I 'fiats of site visit staff: <br /> � � r <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: N r "t <br /> Page 1 of <br /> Burnett County,WI Land Use Application—Rev 03/2017 <br /> � �tl <br />