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LAND USE PERMIT APPLICATION —Burnett County, WI a r" <br /> Applicant Complete All Sections Below This Line J <br /> Permit Types and Fees:(Check appropriate box/boxes) a <br /> DwellingTrincipal Building-Single Family $300 11 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 0 <br /> Commercial/Industrial Building $300 Addition to CommerciaUlndustrial Building $200 ) <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> n <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 <- <br /> Accessory Structure-Commercial(Cl &I I) $200 Addition to Accessory Structure-Commercial(Cl &111 $200 0 <br /> Deck/Stairs/Patio/Retaining WalUSidewalk/Driveway& Gazebo(W I Stat 59.692(1 v)) $350 rn <br /> Campground Structures $125 Filling/Grading $150 <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 .9 <br /> ro <br /> Permit Extension(Valid for one year-Only I Allowed) $100 0 9 <br /> z <br /> 'NOTE:After-the-face(when no permit is obtained prior to construction)is up to th ree times the normal fee. ` <br /> 'Communication Towers&Signs require a different applicattonform,see corresponding application andlees. =' I <br /> "Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Property Owner's Name: A^ ALO 1( 3 z <br /> qO <br /> Property Owner's Mailing Address: 1 to S STI Osco W Z SqD?AIf a <br /> �//,� 1 Ci State Zip o <br /> Property Site Address: 2- Q 3 1 2 �j{ cw, �lc4c- Lo. w-e-65�r t W 1 s%4913 0 <br /> Contact's Telephone Number: <br /> ' o0 <br /> Contact's Email: 71Lt.LdL . CA.yh.V ( f? C✓11nG_�•� Cow". COq <br /> Legal Description of Property: t��-1 <br /> Section#: - L Town#: 'f C N Range W Town of: {4e_C, ,.t <br /> 0 <br /> •Attach additional page if needed for lengthy description OR attaacchga copy of the deed OR attach tax system property page.• ` <br /> Tax ID#(1-5 digit number; found on tax statement): 3 1 3 C_ <br /> Proposed Use of Structure/A dition: GA_R� <br /> Anticipated Start Date: '1 (n r (Home/Cabin:Commercial Business:Bedroom;Deck;etc)) <br /> NZ) <br /> Building Contractor: rVX N S el f Sewer Installer: Nth <br /> // D <br /> � L z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: �INr}I <br /> 1 ` l Fee Rec: �SO' <br /> / 1 N <br /> N <br /> O <br /> z <br /> Z vn <br /> Date of staff site visit: � — �� In'tials of site visit staff: n <br /> r <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE A M&-1 <br /> as <br /> Page 1 of 3 <br /> Burnett County, WI Land Use Application-Rev 03/2017 <br /> F <br />