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LA1NL Un& FLKMll AYYL1UAI IViN — Liu rnett l.ountV, W g b <br /> Applicant Complete All Sections Below This Line o <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> Deelling/Pnncipal Building-Single Family $300 1 Addition to Dyelling/Principal Building-Single Family S200 <br /> DHellinp/Principal Building-Multi-Family $300 1 Structural Alteration to Dyelling/Principal Buildings $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaUlndustrial Building $200 1 <br /> M <br /> Accessory Structure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 <br /> Accessory Structure-Commercial(Cl &11) $200 Addition to Accessory Structure-Commercial(Cl &11) $200 <br /> Deck/Stairs/Patio/Retaining Wall/SidcvAdk/Drive%wy& Gazebo(W1 Sat 59.692(lv)) $350 C10 <br /> Campground Structures S125 rX Filling/Grading 5150 • <br /> Camping Unit(Six Months Per Year) $100 Boathouse $500 <br /> to <br /> Permit Extension(Valid for one year-Only 1 Alloyed) $100 1S <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 /> */terns not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: 14crmAS a%aST 4 <br /> 1 .1o ti <br /> Property Owner's Mailing Address: I CO 3 �i E t tpw (2 t V£IZ � K11 5-4&61 a <br /> City State Zip 2 <br /> Property Site Address: /�Ctw,e dS 4QmtrC, <br /> 1 ' <br /> Contact's Telephone Number:��l OT7 4 N <br /> 1 <br /> Contact's Email: - "!jerSf Q `{c.kpy. C!av*t o <br /> W <br /> Legal Description of Property: �tF !Y� +kt- NY cc 4-1w <br /> Section#: 29 Town#: 39 N Range#:_f�W Town of: RUSK W o i <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system property page.* /1 , <br /> Tax ID#(1-5 digit number;found on tax statement): / IVI�I y 1 <br /> Proposed Use of Structure/Addition: Qarjjen \ TI-PLn� <br /> Anticipated Start Date: Ti e 253 2.017 (Home/Cabin;INmynercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: `pe*% �> Sewer Installer: z <br /> 7y <br /> AREA BELOW THIS LINE RESERVED FOR ZONING STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> . \/ hR - I b - ► 7 <br /> Fee Rec:�� <br /> H <br /> m <br /> C <br /> Date of staff site visit: lniti Is of site visit staff: 54 Z <br /> M z <br /> PERMIT APPROVED BY ZONING OFFICIAL: DATE: C? <br /> CC° <br /> Page 1 of 3 Z �11f <br /> Burnett County,WI Land Use Application—Rev 03/2017 <br />