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LAND USE PERMIT APPLICATION - Burnett County, WI a c <br /> Applicant Complete All Sections Below This Line <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 Structural Alteration to Dwelling/Principal Buildings $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 1 <br /> Accessory Structure(Non-Bunkbouse) $150 Addition to Accessory Structure $150 <br /> 0 1 <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 <, <br /> Accessory Structure-Commercial(CI &I I) $200 Addition to Accessory Structure-Commercial(CI &11) $200 c n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Gazebo(WI Stat 59.692(lv)) $350 <br /> Campground Structures $125 Filling/Grading $150 <br /> w <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 <br /> m <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 r- <br /> o <br /> z <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. ° <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. o <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. fl <br /> Property Owner's Name:/ j��" LJ, VELyzarl C Ou f 4 X z <br /> S y � <br /> Property Owner's Mailing Address: I< ,, e- r. i Ste/ a c> <br /> P X W A City vtate yZin <br /> ^ 0 <br /> Property <br /> Site Address: 7 u 14;1 L o/Ad J� PId r, �` J�7dCJl7 1 <br /> ep (10 N b <br /> Contact's Telephone Number: _) a o0 <br /> Contact's Email: 46eacher «{6{J�'?dcL4 ran_ da` 1 , com o <br /> Legal Description of Property:L04 *3 C-sm VeilA /0418 T 'n 6 a 4 1�{K c. 235*TYjW lj f �f `^ ) <br /> Section#: Town#: N Range#: W Town of: `n <br /> o � <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page.* 1 <br /> Tax ID#(1-5 digit number;found on tax statement): <br /> 1 <br /> Proposed Use of Structure/Addition: dd14:o.�� e,i Po$et� f c[, O n CLO(, c l G Co.�t n <br /> Anticipated Start Date: �!', (Home/Cabr Commercial Business,Bedroom;Deck;etc.) <br /> P r3c`� <br /> Building Contractor: i(!ct @ L,a+►l-fit u[+m� P1da wer Installer:AIQ- z <br /> 7u <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY `— <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: (13 <br /> J Fee Reaba_S__1M <br /> x <br /> y <br /> z C <br /> Date of staff site visit: Initials of site visit staff: M <br /> A o �. <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: X50 N <br /> 0 <br /> m 1� <br /> Page 13 0 <br /> Burnett County, WI Land Use Application—Rev 03//2017 <br /> 3 <br /> v <br /> x <br /> M <br /> a <br /> m <br />