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110 t" <br /> LAND USE PERMIT APPLICATION-Burnett County WI <br /> Permit Fees: c <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> d <br /> DwellingfPrincipal Building-Multi-Famil $300 Addition to Dwellin rind al Buildin -Multi-Famil $200 v <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Buildingv$200 1� <br /> Accessory Structure(Non-Bunkhouse) l O <br /> Addition to Ace.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(Cl &I1) $200 Addition to Accessory Structure-Commercial Cl &Il $200 i } 1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& 0 1 l <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(1 v)) $350 r <br /> Camping Unit $100 Filling/Grading <br /> $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 Boathouse $500 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. ro <br /> *items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. <br /> Applicant Complete All Sections Below This Line c <br /> Applicant's Name: C Alel S w •e vl 5 a.h <br /> Applicant's Mailing Address: ,C)J 9 a a. TdN►� S Dh LtkP lN�b$tf y 1N 1 5`l 3 b <br /> City State Zip < <br /> V <br /> O 15 &6 —/ 71-3 <br /> - <br /> Applicant's Telephone Number: '7/3 - a <br /> 0 <br /> Applicant's Email: p S w e n e, a M Im 5 n r ('D n1 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. oorii <br /> ❑Letter Phone ❑Email <br /> Legal Description: v <br /> Lot#: CSM Vol. Pg. OR <br /> y <br /> Lot#: Block#: Subdivision Name: OR <br /> f � <br /> Gov't Lot#: OR ty w 1/4 A/hU 1/4 l <br /> II 1 <br /> Section#: Town#: N Range#: W Town of: 0 o.. K 1 o-,n J' <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits): 07- ole -D.'Ll'D-1'/o —Z 5-.Z' 0;,-000 -01S600 <br /> / I <br /> Tax ID#(1-5 digits): 1364 <br /> 4 2 y <br /> Property Site Address:a7VRZ JaA&Fon ` A-sle /\ W <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> 13 Single Family Dwelling L3 Multi-Family Dwelling L3Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure r--'11 <br /> LJ Permit Extension E3 Gazebo–WI Stat 59.692(ly) El Camping Unit Ll Commercial Acc. Addition 7:0 <br /> ❑ Boathouse ❑ Screen porch–campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway C <br /> Proposed Structure/Addition Use: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) —7 N <br /> Building Contractor: l9 A Ali S w gn i orl Master Plumber: a <br /> Anticipated Start Date: T!g Y\, <br /> Page 1 of 4 411 <br /> Burnett County,WI Land Use Application —Rev 3/2016 �� <br />