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LAND USE PERNUT APPLICATION— Burnett County, WI a ro <br /> Applicant Complete All Sections Below This Line a "� <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> c � <br /> Dwelling/Principal Brulding-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 0 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structtae(Non-Bunkhouse) $150 Bunkhouse $250 <br /> G] <br /> Addition to Ace.Structure $150 Addition to Accessory Structure-Commercial(Cl &11) $200 < <br /> Accessory Structure-Commercial(Cl &I1) $200 Gazebo(WlStat 59.692(lv)) $350 _ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Filling/Grading $150 d <br /> Campground Screen Porches $125 Boathouse $500 <br /> m <br /> Camping Unit(Six Months/Year) $100 <br /> �o <br /> Permit Extension(Valid for one year-Only l Allowed) $100 <br /> Z <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. ° <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> 1, n <br /> Property Owner's Name: �)C3.Lr4,s <br /> Property Owner's Mailing Address:31 15 Co,9,C) , 1N(- <br /> _ City State Zip d <br /> Property Site Address: AML <br /> Contact's Telephone Number: JS —uo10 UO3Q- N ov <br /> a <br /> Contact's Email: <br /> o <br /> Legal Description of Property: LCT ( Crim 1)Z1 P28S 6_13b4a J � 0171 > l <br /> Section#: Zt$ Town#:_ACSZ-N Range#: W Town of: <br /> TTTT �7� c i <br /> *Attach additional page if needed for 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): I y <br /> Proposed Use of Structure/Addition: air 06e IK hyo v,-,ke— <br /> Anticipated Start Date: M 7-0 0 (Home bin; mmercial Business;Bedroom;Deck:etc.) <br /> x <br /> Building Contractor: txlu,ti101,2_.. Sewer Installer: n z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TOALLCONDITIONS LISTED BELOW:I <br /> t5. ,\ v� <'Y1er e� n\-55. <br /> Fee Rec: <br /> c' yr e (-\) amu.\ (!�>!� �``c �r� S le a T <br /> I V,c c-Q�- Ca. v t. �� C. v t C <br /> YY� C Ay S o o U 1ZC <br /> S 5c , o b, lttziw Cv��k i N Z z <br /> Date of staff site visit: 1 3 Initials of site visit staff- 0 t-+ <br /> -I�� — v o <br /> PERMIT APPROVED BY ZONING OFFICIAL: I/`Yl�v DATE: 2- 17 )0 0 <br /> Pagel of 3 <br /> Burnett County,WI Land Use Application—Rev 1/2017 <br />