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LAND USE PERMIT APPLICATION — Burnett County, WI a t~ <br /> Permit Fees: <br /> Dwellin g/Princi al Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 d <br /> Dwelling/Principal Building-Multi-Family $300 Addition to DwellingTrincipal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 / <br /> Accessory Structure(Non-Bunkhouse) l� I <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(CI &11) $200 Addition to Accessory Structure-Commercial(C1 &Il) $200 0 <br /> Deck/Stairs/Patio/Retaining WalUSidewalk/Driveway& <br /> (Screen orches-in campgrounds only) $125 Gazebo(WI Stat 59.692(lv)) $350 r, <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Permit Extension Valid for one year-Only l Allowed) $100 Boathouse $500 <br /> m <br /> e <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is tip to three times the normal fee. ' <br /> *Communication Towers&Signs require a d&rent application fibrin,see corresponding application and fees. ti <br /> *Items not listed above will be treated as accessory structures,such as. pergolas, landscaping,etc. <br /> 0 <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: J Ot ll e e k-ffwt T <br /> Applicant's Mailing Address: T•fl. 30 39 s 404ar LUT T b <br /> 3019(* Sd p-K4 Lei 0,4,1 Cit3f State zip <br /> c e <br /> Applicant's Telephone Number: CGII' /a <br /> a <br /> w <br /> Applicant's Email: -T'1 ec kC to (, P�n ��t(/-)• c....., ) <br /> 00 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> / ❑Letter [Phone $Emai CIYf � SirAWf <br /> Legal Description: L.1• f OC CSW) V. 7 , P /68 1# 30//r 0) 94 3 w NW) d 1 <br /> 5. <br /> Lot#: CSM Vol.-_Pg. IN OR � <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1A 1/4 Iv <br /> � � }} -� <br /> Section#: 7j0 Town#:��N Range#:��W Town of: SWC i S l/" <br /> *Attach additional page if needed for lengthy description OR attach a copy gfthe deed OR attach tax.vrtem property page.* :" <br /> r <br /> In <br /> Parcel#(24 digits): 07- 03x1,-a-41 - IS- 3o-a 0y-0VV-D/Vav P� N <br /> ^� z <br /> Tax ID#(1-5 digits): of 7 a y <br /> Property Site Address: 301V6 b 'ord ftA L ILS - b4o4 an k/L St4 no ' <br /> TYPE OF PERMIT(S): Check appropriate box/boxes e S O <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 Y Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition C0 <br /> ❑ Boathouse ❑ Screen porch�-cammppgrouunds only�❑ Retaining Wall LlC <br /> Sidewalk/Driveway <br /> Proposed Structure/Addition Use: SWR 62!n C, N m D <br /> //�� (Home/Ca in;Conemercial Business;Bedroom;Deck;etc.) Z � u u <br /> Building Contractor: RP 5 eyslkoYwohon Master Plumber: ��� Z0 <br /> a) o o <br /> Anticipated Start Date: 5 p C rn <br /> Page 1 of 4 <br /> Burnett County, WI Land Use Application-Rev 3/2016 <br />