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r <br /> LAND USE PERMIT APPLICATION —Burnett County, WI <br /> Z - <br /> Permit Fees: g 1 6 <br /> Dwelling/Principal Building-Single Family S300 Addition to Dwelling/Principal Building-Single Family $200 O (, <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Famil $200 <br /> Commercial/Industrial Building $300 Addition to CommercialAndustrial Building S200 <br /> Accessory Stmcture(Non-Bunkhouse) <br /> Addition to Ace.Structure $150 Bunkhouse $250 1 <br /> Accessory Structure-Commercial Cl&11 $200 Addition to Accessory Structure-Commercial Cl&11 S200 <br /> L7 1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& g <br /> Screenporches-in campgrounds only) S125 Gazebo WI Stat 59.692 lv S350 <br /> Camping Unit $100 Fillin Gradin $150 <br /> Permit Extension(Valid for one year-Onl IAllowed $100 Boathouse $500 <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. a <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> 0 3 <br /> Applicant Complete All Sections Below This Line z <br /> Applicant's Name: DoyG1ks FG /QSr+C�A-s �•SF 9r4r� <br /> Applicant's Mailing Address: 7oi C�f�Vlt ✓ � n�e Q e�i.� y city State Zip <br /> Applicant's Telephone Number: 00 - 4/7s /571 o a <br /> 2 <br /> Applicant's Email: 0j%0A1A jo� Id e-Q1_4 .Le.oWl olo�Aa/1 <br /> o <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> ❑Letter OPhone Wmail <br /> Legal Description: Sty• 01(0 ry 1, N g (St-✓ ° ��� <br /> Lot#: 6;�. (_4 CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: A OR 1/4 1/4 <br /> Section#:-6 Town#:__9&LN Range#: /5- W Town of: Sw is SS <br /> *Attach addiitonal page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* i <br /> 07� 1-q1-/s--24-6- <br /> Parcel#(24 digits): 63a- OS - 06 Z—t52 /cacao � '\ <br /> Tax ID#(1-5 digits): R14 z <br /> Property Site Address: 30a73 C I r0+ S�lw-son foacC <br /> d <br /> a <br /> TYPE OF PERMIT(S): Check appropriate box/boxes <br /> Fee Rec: <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs ❑ Acc.Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc.Structure <br /> ❑Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑Camping Unit ❑Commercial Acc.Addition <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑Sidewalk/Driveway <br /> /n <br /> Proposed Structure/Addition Use: R'"&Vk- C"iA_ <br /> -� /�rp� (Home/C O <br /> /abm;Commercial Business,Bedroom;Deck,etc.) Z <br /> Building Contractor: /76t f// f4ycfLtOot. Master Plumber: N p <br /> Anticipated Start Date: �0�1C1( l� Wj- 04-one 45-c ) Z 1 l�lU <br /> Zo <br /> o <br /> rn CSO <br /> Burnett County,WI Land U T <br /> ation-Rev 30 <br /> Z <br /> AUG - 3 2011 i <br /> BURNETT COUNTY <br /> ZONING <br />