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LAND USE PERMIT APPLICATION - Burnett Countv, WI r <br /> a � b <br /> Applicant Complete All Sections Below This Line c <br /> Permit Types and Fees:(Check appropriate box boxes) <br /> b <br /> Dwelling/Principai Building-Single Family $300 11 Addition to Dwelling/Principal Building-Single Family $200 m^, <br /> _7711-11g/Principal Building-Multi-Family 5300 Structural Alteration to Dwelhng/Principal Buildings $200 — <br /> CommerciaVlndustrial Building $300 Addition to Commercial/lndustrial Building $200 n <br /> `1 <br /> Accessory Structure(Non-Bunkhouse) $1110 jAddition to Accessory Structure $150 <br /> C X <br /> 0 <br /> Bunkhouse X250 Structural Alteration to Accessory Structure $150 <br /> Accessory Structure-commercial(Cl &11) X2I10 Addition to Accessory Structure-Commercial(Cl &II) $200 0 <br /> Deck/Stairs/Patio/Retaining WaIVSidewalk/Driveway h met furl Stat 59.692(lv)) $350 <br /> Campground Structures X12,, Filling/Grading $150 <br /> Camping Unit(Six Months Per Year) $I o0 Boathouse $500 <br /> m <br /> Permit Extension(Valid for one year-Only I Allotted) $100 <br /> z <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. 0 <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,hutdscaping etc e <br /> �• n <br /> AIberl a k � , ti l l <br /> Property Owner's Name: all put t a 2rlri �.A.rrU-I 1/J/la_1 p D �� � <br /> Property Owner's Mailing Address: 3 6Q /� /JCr;� 4akv- t4vr w3D 2. a <br /> kn & City State Zip o <br /> Property Site Address: X X x K Lb//1b ICed jC.D p� n <br /> Contact's Telephone Number: 6 5i,- 7o 2- -3313 CKerr) b a <br /> Contact's Email: kerrhbme(dC-nkrul)'nk.net o <br /> I AboaaNdS l��- j� <br /> Legal Description of Property: W)• d II fie � <br /> Section#:I Town#:-r © N Range#:RJ t> W Town of: lac kSO n W <br /> 1 <br /> *Attach additionsl page if needed for lengthy description OR attach a copy of the deed OR attach tsar system property page.* 1 <br /> Tax[D#(1-5 digit number;found on tax statement): <br /> 163 1 �' <br /> Proposed Use of Structure/Addition: 5 TD G gQrage_/5I1 e l <br /> Anticipated Start Date: (home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> ro <br /> n <br /> Building Contractor: S e Sewer Installer: 117 z <br /> ad <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDMONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Iv 1 <br /> M \fS � obi-�, �, str�4Z <br /> 1 Fee Rec: ��• <br /> 1 <br /> 1j 0- <br /> M° r� ��S v11Oof� d� y <br /> 5�,-,0.1 nod �x�.,���9, 3 S ' `, •� �n�;� �� <br /> i4 n CCT <br /> Date of staff site visit 1 Initials of site visit staff: M C <br /> PERMIT APPROVED BY ZONING OFFIC DATE: th <br /> ' 90 <br /> Page 1 of 3 o Z <br /> Burnett County,WI Land Use Application—Rev 03/2017 1 �_ <br />