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LAND USE PERMIT APPLICATION—Burnett County, WI a _ <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $30 Addition to Dwellin rind al Building-Single Family $200 a <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse $250 t <br /> Accessory Structure-Commercial CI &11) $200 Addition to Accessory Structure-Commercial Cl &I 1 $200 ^ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& Ov,c <br /> (Screenporches-in campgrounds only) $125 Gazebo(WI Stat 59.692 lv $350 <br /> r <br /> Camping Unit $100 Fillip Gradin $150 0- <br /> ° <br /> Permit Extension(Valid for one year-Only I 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 /> 1 <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. ti <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. �� r <br /> Applicant Complete All Sections Below This Line <br /> Applicant's Name: O�r1 K0.1^S>✓� 013 <br /> Applicant's Mailing Address: -1 p i IJrt�n�W it �� 1, SaYaal hh) SS37 <br /> City rj State zip c <br /> Applicant's Telephone Number: 1 IS-3O a - <br /> a <br /> d <br /> Applicant's Email: fD <br /> If staff has auestion about this application how refer to be contacted? Check one below. W <br /> 9 PP do 90 Y( P �m�ttr N <br /> _"r\r r' S q moU l o COM ❑Letter j�Phone ❑Email -7/S- (pc//-0 S ;L �' <br /> Legal Description:I,p 3 m v i o p/a`(Y) n &I 101 -1 114 C�,,, L.o+ S v <br /> Lot#: �O <br /> _CSM Vol. / O Pg. �a37, a 3�, a 3� 5. <br /> (� �..\ <br /> Lot#: _Block#: Subdivision Name: OR / o <br /> Gov't Lot#: f�;7OR 1/4 t/4 d <br /> Section#: Town#: N Range#: _W Town of:�OLL�Sot1 1 <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): 6-1 IS-OS — 001 — O 1(p <br /> / z <br /> Tax ID#(1-5 digits): Baa CQ y <br /> Property Site Address: pX XY, MkT �e`� w N 3 2 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes � a <br /> Fee Rec:3W.60 <br /> Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition C <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway <br /> Q -ocXV. S 0 l�rqtr u,1 <br /> Proposed Structure/Addition Use: Z <br /> O/'1'Je: <br /> -�' (� (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) / Q <br /> ) .�`T+ <br /> Building Contractor; rn w aster Plumber­ /S ��ur+t a�ir1a t Z O0 CS <br /> Anticipated Start Date: OZ ce ,�feA-4 I'1 � O CC s <br /> Page 1 of 4 Z <br /> UAL&) Burnett County,WI Land Use Application—Rev 3/2016 =J <br />