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LAND USE PERMIT APPLICATION — Burnett County. WI a <br /> Applicant Complete All Sections Below This Line W <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <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 l <br /> Accessory Slruc[ure(Non-Bunkhouse) $150Bunkhouse $250 ~ <br /> ET 0 <br /> Addition to Acc.Structure $150 Addition to Accessory Structure-Commercial(Cl&11) $200 � <br /> Accessory Structure-Commercial(Cl &11) $200 Gazebo(WI Stat 59.692(iv)) $350 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Drive-way& Filling/Grading $150 <br /> Campground Screen Porches $125 Boathouse $500 �+ <br /> Camping Unit(Six Months/Year) $100 y <br /> m <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 <br /> z <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treater/as accessory structures.such as:pergolas,landscaping,etc. <br /> � <br /> // n W <br /> Property Owner's Name: &najd CL� &t-6 arL2 l�C 12 z <br /> o <br /> Property Owner's Mailing Address: 5 15-27- CotL4 �c� � /rna. Cc!/ ,5 610 0. <br /> /�} ^� ', '� , 1� City State Zip p <br /> Property Site Address: tr�0 04�/+ f%V�1 <br /> Contact's Telephone Number: tOojp—�p4.5,_ <br /> S' t <br /> Contact's Email: • <br /> Legal Description of Property: 4o4 /2 Boss flake tures E % AIW Y1�4 <br /> Section#: 19 Town#: q1 N Range#:__L$' W Town of:�S",)/SS <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* \ b E t <br /> Tax ID#(1-5 digit number;found on tax statement): aas�I(f -1 <br /> Proposed Use of Structure/Addition: ( tlpJ,b,� �g�n�rhor� Q v 1�khpv SQ <br /> Anticipated Start Date: <br /> Cabin;Commercial Business;Bedroom;Deck;etc.) � <br /> Building Contractor: pre -(90ns4ruc4LJ Sewer Installer: loss 75-hnde r- n Z <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDrTIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> sclsoo <br /> N � <br /> c7 M t),V)to 41%zk r CA I V1 Fee Rec: <br /> C <br /> 02 � <br /> Date of staff site visit: Initials of site visit staff: Q z w <br /> C1 N <br /> C=3 <br /> � � <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE—�— <br /> a-3- i z <br /> Page 1 of �►�� <br /> Burnett County,WI Land Use Application—Rev 10/2016 <br />