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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> 6 <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Check appropriate box boxes) e <br /> 0 <br /> Dwelling/Principal Building-Single Family $300 11 Addition to DvvellingiPrincipal Building-Single Family $200 rn <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwulling/Principal Buildings $200 O <br /> 1 F <br /> Commercial/Industrial Building $300 Addition to Commercial/[ndustrial Building $200 � <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 �1 <br /> L) 11 <br /> 0 <br /> Bunkhouse 5250 Structural Alteration to Accessary Structure $150 <br /> Accessory Structure-Commercial(Cl &Il) $200 Addition to Accessory Structure-Commercial(Cl&Il) $200 0 �— <br /> Deck/Stairs,Tatio/Retaining WatVSidewalkiDrivcway& Gazebo(WI Stat 59.692(1v)) $350 U, <br /> Campground Structures $125 FillinglGrading $150 <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 r ? <br /> ro <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 _ <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 diferent application form,see corresponding application and fees. c {� <br /> *items not listed above ivill be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> 1 <br /> Property Owner's Name: �y�ln a 1 r. �D ba Z <br /> Property Owner's Mailing Address: yy AV-C IS n 5-5° /o c <br /> �1 ity State Zip o <br /> Property Site Address: A 7 7 Y W h Te- P;nt 1 r L <br /> Contact's Telephone Number: -Tt-r a o0 <br /> Contact's Email:'�rP-r t n C.5I'4Lr [a_.rv�S h• Cts n <br /> f� <r� d <br /> Legal Description of Property: L-0-r ?F p 14-T B W h i `�(�L> (K� <br /> Section#: Town#: N Range#: W Town of.. 'Tt•a e(a b-Kt. -hwN5*h`P r <br /> 0 <br /> *Attach additionalpage if neededfor lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Tax ID#(1-5 digit number;found on tax statement): 3 g ! <br /> Proposed Use of Structure/Addition: 5`C14- Wo.1 K r I <br /> Anticipated Start Date: M k X' .2-6)1 (Home/Cabin;Commercial Business;Bedroom;Deck,etc.) • 1y\1' <br /> n � <br /> Building Contractor: 5�1 f Sewer Installer: z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTSICONDITIONSQNLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> E <br /> Fee Rec: las <br /> m <br /> 6 <br /> m <br /> N <br /> O <br /> Z <br /> Z <br /> L <br /> Date of staff site visit: lni ials of site visit staff. <br /> o <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE L <br /> �n <br /> n <br /> m <br /> Page 1 of 3 0 <br /> Burnett County, WI Land Use Application-Rev 03/2017 a <br /> b <br /> m <br /> A <br /> m <br />