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r <br /> L UNI) Unib VEKMil AYYLII;AIIkKN — lsurnettuountV, W1 Cr C� <br /> N N t✓ <br /> Applicant Complete All Sections Below This Line ,-°, <br /> Permit Types and Fees:(Check appropriate box/boxes) <br /> d <br /> Dwelling/Principal Building-Single Family S300 Addition to Dwellinp/Principal Building-Single Family $200 m <br /> Dwelling/Principal Building-Multi-Family $300 1 Structural Alteration to Dwelling(Principal Buildings 5200 O <br /> Commercial/Industrial Building $300 Addition to Commercial/Indsirial Building $200 1 <br /> Accessory Struclure(Non-Bunkhouse) $150 Addition to Accessory Structure $150 <br /> 0 <br /> Bunkhouse $250 Structural Alteration to Accessory Structure $150 < <br /> Accessory Structure-Commercial(Cl &11) 5200 I Addition to Accessory Sincture-Commercial(Cl &11) 5200 0 C_ <br /> Deck/Stairs(Patio/Retaining Wall/Sidewalk/Drivemy& Gazebo(WI Stat 59.692(l v)) $350 <br /> Campgrowd Structures $125 Filling/Grading 5150 g�g <br /> Camping Unit(Six Months Per Year) SI00 Boathouse $500 <br /> 0 <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 <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 application form,see corresponding application and fees. � <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. z7 <br /> �• n <br /> Property Owner's Name: Q LJ h Fe—ir r � z <br /> Property Owner's Mailing Address: Z'7'I 7 2 Ilk Q ski- <br /> a <br /> p City State Zip d <br /> Property Site Address: 2--77 ( 1 4-2 �S <br /> Contact's Telephone Number: o M <br /> �G (Z /��q� �S Z -�' � <br /> Contact's Email: Q / i l n 11S t q/ 'Mac CW\, v <br /> S <br /> Legal Description of Property: Li � n <br /> Section#:5 _.Y_5 Town#: 111 a N Range#: R lb W Town of: C1Czk` Q r\a <br /> o � <br /> *Attach additional page ijneeded for lengthy description OR attach atop/y of the deed OR attach tax system property page.* 1 <br /> Tax ID#(1-5 digit number;found on tax statement): I_-�/Q 11� 1 y <br /> Proposed Use of Structure/Addition: V,1 k Cv,-Pk, <br /> Anticipated Start Date: r'�! 1-7�'+ (Home Cabin;Commercial Business.Bedroom Deck etc.) <br /> Building Contractor: rX q uh rl � CaL-Acm Sewer Installer. tYl � � z t Al <br /> AREA IN <br /> BELOW TMS LE RESERVED FOR ZONING STAFF COMMENIFS"NDITIONS ONLY N Vv <br /> THIS PERNUT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Fee Rec:O�f <br /> � m <br /> Date of staff site visit: Initials of site visit staff: � Z C <br /> �1 - 7 0M - <br /> PERMIT APPROVED BY ZONING OFFICIAL: n DATE: <br /> P 2p w <br /> Page 1 of 3 <br /> Burnett County,WI Land Use Application-Rev 03/2017 <br />