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LAND USE PERMIT APPLICATION — Burnett County, WI b r <br /> a R C-, <br /> Applicant Complete All Sections Below This Line 0' <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> d <br /> Dwclling/Principal Building-Single Family 5300 jAdditicm to Dwellin,v,/Principal Building-Single Family $200 n <br /> Dwclling/Principal Building-Multi-Family 5300 Structural Alteration to Dwclling/Principal Buildings $200 <br /> Commercial/Industrial Building 5300 lAdditi,n to Commercial/Industrial Building $200 1 � <br /> Accessory Structure(Non-Bunkhouse) Addition to Accessory Structure $150 ) <br /> n <br /> Bunkhouse 5250 Structural Alteration to Accessory Structure $150 0- <br /> Accessory Structure-Commercial(CI &I[) S200 Addition to Accessory Structure-Commercial(CI &11) $200 c �^ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Cazebo(WI Stat 59.692(lv)) $350 ti <br /> Campground Structures $125 Filling/Grading $150 <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 .9 <br /> Permit Extension(Valid for one year-Only I Allowed) $100 r- <br /> c <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. M <br /> 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas.landscaping,etc. <br /> /� <br /> Property Owner's Name: /-1 t C6 e) Fre e b epi <br /> z <br /> p f� < � <br /> Property Owner's Mailing Address: P0, sor- � C O/Tdt,X. ArD SSo IS c o <br /> q^ c7// 1� City State Zip <br /> ?a76 o <br /> Property Site Address: C 0, L� me Ro o A� Siren W: -<A F <br /> Contact's Telephone Number: 7Q I 6'�O 0 9 <br /> Contact's Email: M FR>✓EPf-RCD l", CTM F/1 ISM • C�M DQ <br /> 00 <br /> o I <br /> N <br /> Legal Description of Property: S E S W EX E,6 6o' L $, <br /> Section#: 3 I{- Town#: 38 N Range#: 17 W Town of: A el S <br /> 1 jj 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): <br /> Proposed Use of Structure/Addition: St",{age <br /> r <br /> Anticipated Start Date: A!45. ;ko)7 (Home/Cabin;Commercial Business;Bedroom;Deck:etc.) O <br /> n Cj <br /> Building Contractor: GCe?% Fn4NG1 Hat't Sewer Installer: /I011A z <br /> A <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Fee Rec:1 (�V <br /> H <br /> S <br /> N <br /> ti <br /> O <br /> m <br /> N <br /> O <br /> z_ <br /> _ J > <br /> Date of staff site visit: —� 1 Initi sof site visit staff: a C <br /> a-� <br /> m z <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: �z l <br /> 0 CAD <br /> i O o t� <br /> Page 1 of 3 o C <br /> Burnett County, WI Land Use Application—Rev 03/2017 > z 'U1 <br />