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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> Z <br /> Applicant Complete All Sections Below This Line <br /> c � <br /> Permit Types and Fees:(Check appropriate box/boxes) e <br /> Dwelling/Principal Building-Single Family $300 Addition to Dtxelling/Prmcipal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Familv $300 Addition to DvellingiPrincipal Building-Multi-Fainih $200 <br /> \ A <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 � <br /> Accessory Structure(Non-Bunkhouse) $I50 Bunkhouse $250 �e L) <br /> Addition to Ace.Structure $150 Addition to Accessory Structure-Commercial(Cl &ll) $200 <br /> �1 <br /> �,,ory Structure-Commercial(Cl&ll) $200 Gazebo(Wl Stat 59.692(lv)) $350 a <br /> Deck;Stairs/Patio/Retaining Wall/Sidewalk/Drivemy& Filling/Grading $150 <br /> Campground Screen Porches $125 Boathouse 5500 m' <br /> Camping Unit(Six Months/Year) $100 <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 e <br /> Z <br /> *NOTE After-the-fad(when no permit is obtained prior to construction)is up to three times the normal fee. ° <br /> 4 <br /> *Communication Trovers&Signs require q different applicationform.see corresponding application and fees. c <br /> *Gems not listed above will be treated as accessorystructures,such as:pergolas,landscaping,etc.. o <br /> Property Owners Name:/�upn F } ,'G n�ra /`t�p(Sd/x iYQcl.�(�t5 Z <br /> Property Owner's Mailing Address: gla5,5 1:1' .5i. So gntY /-;V 56 �—a <br /> City State Zip 777CCC d <br /> Property Site Address: Q C)/ L c1 PY 0 rAi` R til (� 510; wZ Sys <br /> Contact's Telephone Number: 904 - e7q Y Olt w 1 <br /> Contact's Email: tJA/I. r. /ir.0•PrStl•'�� Gnj 9.YtG lei. urv- p <br /> y <br /> I /,t1 a <br /> Legal Description of Property: PILI s L,,::, .1 t� Otk d t- O r r W0 t/�CZ 4A /H[��1 <br /> Section#: 3 1p Town#: O N Range#: W Town of: Loin t o n c � <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): Q 5 L(0 <br /> Proposed Use of Structure/Addition: Rtn+oJi ra btn W. �tlJurs�S.d• .°/.,sv.�a f'e.. <br /> Anticipated Start Date: y- /`�-/T? (Home/Cabin:Commercial Business;Bedr Deck;etc.) ° ) <br /> Building Contractor: %>o eve o t-m?r Sewer Installer: —� N H Z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY A I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> I�zln CX"T^4C_C — Fee Rec. <br /> s <br /> 0 <br /> m <br /> N <br /> O <br /> r� <br /> Date of staff site visit —IV Initials of site visit staff.�� W <br /> o C <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE0") Z � <br /> P m <br /> I <br /> Page 1 of 3 020 <br /> Burnett County,WI Land Use Application—Rev 02/2017 ; G) O o <br /> C <br /> = Z f UlI <br /> m <br />