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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> � C <br /> - a <br /> Applicant Complete All Sections Below This Line <br /> Permit Types and Fees:(Check appropriate box/boxes) c <br /> Dwelling/Principal Building-Single Family $300Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 O <br /> Commercial/Industrial Building F$150Addition <br /> ion to Commercial/industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) house $250 1 <br /> L1 <br /> Addition to Ace.Structure ion to Accessory Structure-Commercial(Cl &11) $200 <br /> °< <br /> Accessory Structure-Commercial(Cl &11) bo(WI Stat 59.692(Iv)) $350 rDeck/Stairs/Patio/Retaining WaIVSidewalk/Driveway& g/Grading $150 <br /> Campground Screen Porches house $500 <br /> Camping Unit(Six Months/1'ear) o <br /> Permit Extension(Valid for one year-Only I Allowed) <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 treated as accessory structures,such as:pergolas,landscaping,etc. <br /> � rnii <br /> Property Owner's Name: an 2 ()QA <br /> O y �� <br /> Property Owner's Mailing Address: Box 3 k c <br /> t�}i IL Dr. Q City State Zip <br /> Property Site Address: 7�`� &nbury , �� <br /> Contact's Telephone Number: <br /> 0 <br /> Contact's Email: Aja n r-b�`i F!'V&�p . Com � wlr 4.5 a <br /> v tr <br /> jsarr O <br /> Legal Description of Property: Ofi I CSM #t/7qD V q e-20-Un Sid Ald Hloy/��V3 Pt lb- <br /> Section#: a7 Town#:�_N Range#:��W Town of: SwtS5 Es.nt rn ) <br /> 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* tut = <br /> Tax ID#(1-5 digit number;found on tax statement): %A�t D 1 7 ti <br /> Proposed Use of Structure/Addition: k <br /> Anticipated Start Date: gry/,s find (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z' <br /> Pr <br /> Building Contractor: Srcuc -t ,6. GI[ I ngil Sewer Installer: 0055 Tod�Arnellr Sr�tirr Z <br /> e56n) -1 y <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> a 1� <br /> Fee Rec:J o D <br /> C <br /> Z o <br /> M <br /> / I <br /> Date of staff site visit: 9 p Initials of site visit staff: dam <br /> q <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: I a 19 Co c <br /> rn <br /> Page 1 of 3 <br /> Burnett County,WI Land Use Application—Rev 10/2016 �_J.J <br />