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LAND USE PERMIT APPLICATION — Burnett CountyWI C <br /> y <br /> a <br /> Applicant Complete All Sections Below This Line 0' <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> d I� <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelting/Principal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> C) <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 <_ <br /> Accessory Structure-Commercial(Cl&11) $200 Addition to Accessory Structure-Commercial(CI &11) $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 y <br /> w <br /> Campground Structures $125 Filling/Grading $150 <br /> w <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 <br /> v <br /> rn <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 S, <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three rimes the normal fee. <br /> 0 <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. "n <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 9 <br /> Property Owner's Name: =m ml\� °�l ' \i I ITh( o�— H P,,r r e-r 0 <br /> o <br /> Property Owner's Mailing Addrcss:_H 1 r �e L3 fbl.)I uj y 0 p n \ <br /> City State Zip o <br /> Property Site Address: �nc�t me, � 1 <br /> Contact's Telephone Number: h _RD 9 309\ o <br /> Contact's Email: <br /> Legal Description of Property: E <br /> Section#: Town#: N Range#: W Town of <br /> *A ttach 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 <br /> Proposed Use of Structure/Addition:�G f7n Lk(c <br /> Anticipated Start Date: l / ("e/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> v <br /> Building Contractor: Sewer Installer: y z <br /> N <br /> �a d <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY � G <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: d <br /> I, �I I(3we� <br /> (� 1 lv) ,�1 � 6-vr ��rs <br /> II I- <br /> Fee Rec:�� <br /> d -1'O QY�� S jc77 I f t ✓� e N <br /> ��� J <br /> M <br /> 8 C <br /> Date of staff site visit: Initials of site visit staff. Z <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: I C� oA <br /> C <br /> m C � <br /> Page 1 of 3o Z <br /> Burnett County, WI Land Use Application—Rev 03/2017 D n� <br /> m <br /> A <br /> m <br />