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r <br /> LAINU UNE YEKMll AYYLIUAI IkJIN - tSurnett UountV, W1 a C <br /> f% �1 <br /> Permit Fees: ?� <br /> Dwellin ci al Buildin -S' a Famil $300 Addition to Dwellin ci al Buildin -S' le Famil $200 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family 5200 , <br /> CommerclaVlndustrial Building $300 Addition to CommerciaVlndustrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial CI&Il $200 Addition to Accessory Structure-Commercial C1&Il $200 <br /> C) <br /> Deck/Stairs/Patio/Retaining WaWSidewalk/Driveway& � <br /> Screenporches-in campgrounds only) $125 Gazebo WI Stat 59.692 Iv $350 S <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Ordy 1 Allowed $100 Boathouse $500 I <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. d <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. - <br /> Applicant Complete All Sections Below This Line o <br /> // T � <br /> Applicant's Name: Viz can cJ ea M Me, (� L <br /> Applicant's Mailing Address: to- /li r $rx y .4 A G�it gav� L 54930 <br /> a. b <br /> City State Zip o g 0 <br /> Applicant's Telephone Number: 1S) oZ?S M2 p <br /> tt � <br /> Applicant's Email: 1 �CuS�a►++/lLn+Ct f% 9 r�wo� •tcv+t <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N b <br /> ❑Letter loPhone ❑Email <br /> Legal Description: <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR I� ) <br /> Gov't Lot#. OR 1/4 1/4 <br /> Section#:C1 Town#: s�N Range#:__14 _W Town of <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* t <br /> Parcel#(24 digits):a-QO-!4-09"S 05._009 -Q/6600 � d <br /> y z <br /> Tax ID#(1-5 digits): 17 2 11 <br /> Property Site Address:d29I/Z 6roziG &I hatikgp Ur 6400 <br /> C <br /> TYPE OF PERMIT(S): Check appropriate box/boxes 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 ❑ Aa. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Aa. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition C �1 <br /> ❑ Boathouse L3 Screen porch-campgrounds only ❑ Retaining Wall L3Sidewalk/Driveway <br /> �ow'rt �di1� n <br /> Proposed Structure/Addition Use: Z� � <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) M <br /> / 1 / U U Y <br /> Building Contractor: <yhc e„S 65Y6a� /yot+tGS Master Plumber: 'V,- v o <br /> Anticipated Start Date: R'1 ova C - <br /> Page 1 4 <br /> Burnett County,WI Land Use Application—Rev 3/200 16 :� — <br />