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LAND USE PERMIT APPLICATION—Burnett County WI a <br /> Applicant Complete All Sections Below This Line <br /> a <br /> Permit Types and Fees:(Check appropriate box/boxes) � a <br /> Dwelling/Principal Building-Single Family $300 1 Addition to Dwelling/Principal Building-Single Family $200 <br /> Duelling/Principal Building-Multi-Family $300 Structural Alteration to DweWng/Principal Buildings 5200 <br /> CommercialAndustrial Building $300 JAddition to Commercial/fndustrial Building 5200 <br /> n <br /> n <br /> Accessory Structure(Non-Bunkhouse) $150 1 jAdditio,to Accessory Structure $150 <br /> O <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 < <br /> Accessory Structure-Commercial(Cl At Il) $200 1 Addition to Accessory Structure-Commercial(Cl&Il) $200 S <br /> Dec Stair atio/Retaining Wall/Rdewalk/Driveway& Gazebo(WT Stat 59.692(lv)) $350 to <br /> Campground Structures $125 Filling/Grading $150 <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 `td <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 1t-, <br /> 0 <br /> *NOTE After-[he-fact(when no permit is obtained prior to construction)is up to three times the normal fee. <br /> 0 <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. v <br /> p• A <br /> Property Owner's Name: 4n.1w L41 <br /> o � x <br /> Property Owner's Mailing Address: g <br /> a <br /> City State Zip <br /> o <br /> Property Site Address: <br /> 7 <br /> Contact's Telephone Number:_ o b <br /> Contact's Email: <br /> Legal Description of Property: l 5. <br /> /� <br /> Section#: M Town#: N Range#: _W Town of: aj 5k a' <br /> *Attach additional page if needed jar 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): y <br /> Proposed Use of Structure/Addition: <br /> Anticipated Start Date: (Homexabin;Commercial Business;Bedroom;Deck;etc.) t <br /> Building Contractor: ewer Installer: z <br /> AREA BELOW TffiS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r©� 6 � �� A e- Fee Rec�t �� <br /> M c. <br /> z <br /> m <br /> 6 <br /> 0 <br /> Z <br /> � y <br /> Date of staff site visit: Initials of site visit staff: Z C <br /> -x-17 Sze <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: 0 c <br /> Page 1 of 3 c V <br /> Burnett County,WI Land Use Application—Rev 03/2017 <br /> x <br /> m <br /> z <br /> m <br />