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L p„-\ Us'e �, <br /> 11 G <br /> Applicant Complete All Sections Below This Line c a <br /> Permit Types and Fees:(Check appropriate box boxes) <br /> DweOing/Principal Building-Single Family $300 jAddition to Dwelling/Principal Building-Single Family $200 <br /> Dweffing/Principal Building-Multi-Family $300 Structural Alteration to Dwelling/Principal Buildings $200 <br /> Commercial/Industrial Building $300 Addition to CommercialAndustrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) 5150 Addition to Accessory Structure 5150 1 <br /> Bunkhouse $250 Structiral Alteration to Accessory Structure $150 a<- <br /> Accessory Structure-Commercial(Cl&11) $200 Addition to Accessory Structure-Commercial(Cl &11) $200 ' <br /> Deek/Stairs/Patio/Retaining Wa]MdemWk/Dzivemay& Gazebo(WI Stat 59.692(lv)) 5350 � <br /> Campground Structures $125 Filling(Grading 5150 41 <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 ,ty <br /> ro <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 S, <br /> Z <br /> *NOTE:After-the-fad(when no permit is obtained prior to construction)is up to three times the normal fee. ° <br /> *Communication Towers&Signs require a different applicationform,see corresponding application andfes. 'y <br /> *hems not listed above will be treated as accessory structures,such as:e pergolas,landscaping,etc. }— d <br /> Property Owner's Name: kAMMOtja- i P��t.1 ��VoAk tPUSI <br /> Property Owner's Mailing Address: <br /> City State Zip <br /> Property Site Address: <br /> o <br /> p p <br /> Contact's Telephone Number: �— q 0 — l� 1 o o b l <br /> /M � �—� e:-Ne ` me- 12e4A 0th.Ccs^^'► 5 <br /> Contact's Email: I1 ��r (� �e� / d d <br /> Legal Description of Property: I' l �P�-t � � � �g� ` PC( &.v. t d+q) g- � <br /> I <br /> Section#: Town#: N Range#: W Town of y <br /> sAaach additional page if neededfor 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: -t- b�L �+ { <br /> Is�c eac,s. ,rtg vJ Q <br /> Anticipated Start Date: (0 1( 1 :1 (Horne/Cabin;Commercial Busmhed Bedroom;Deck;etc.) <br /> 1 <br /> Building Contractor: tigVI� A Sewer Installer: � z <br /> y <br /> x <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> FeeRec:�a5 <br /> / N <br /> 8 <br /> C <br /> I ll 2 � <br /> Date of staff site visit: ` — I J ( Initials of site visit staff: J 0> N Z <br /> Vim. 00� � r� <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: 1 Z C7 <br /> rG) o o C� <br /> M C <br /> Page 1 of 3 0 ° tJ <br /> Burnett County, WI Land Use Application—Rev 03/2017 3 �� <br />