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LAND USE PERMIT APPLICATION —Burnett County WI _ c <br /> a <br /> Permit Fees: cr, <br /> Dwelling/Principal Building-Single Family <br /> $300 Addition to Dwelling/Principal Building-Sin le Family $200 O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> CommerciaVlndustrial Building $300 Addition to Commercial/Industrial Building $200 v <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse $250 t <br /> Accessory Structure-Commercial(CI &11) $200 Addition to A cessory Structure-Commercial(CI &11) $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& 0 1 <br /> <- <br /> (Screen orches-in campgrounds only) $125 Gazebo(W1 Stat 59.692(lv)) $350 <br /> Camping Unit $100 Filling/Grading $150 o <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 Boathouse $500 d <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 dijjerent application form,see corresponding application and jeer. <br /> v <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping, etc. <br /> r _ <br /> o - <br /> T <br /> Applicant <br /> Complete All Sections Below This Line z <br /> Applicant's Name: vlG } <br /> Applicant's Mailing Address: ox i " -tb S a T N SF/1#7o <br /> City State Zip < <br /> Applicant's Telephone Number: (Q� 1- 09 4S ^ l SCo c <br /> Applicant's Email G.C.tie. T C t C YV►AJ. ctnj <br /> v lP t <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N °' <br /> ❑Letter 4ephone ❑Email 71 o S <br /> c� A � <br /> Legal Description: t) , J o�nr\sen � ?cl 7Gu n�Uhf(I �I `� u d <br /> Lot#: CSM Vol. Pg. OR 4. <br /> n � <br /> Lot#: Block#: Subdivision Name: OR o -' <br /> Gov't Lot#: C o OR C—, 1/4 1/4 I. 1 I <br /> Section#: I Town#: 40 N Ran #ge :��W Town of: 00..x- <br /> *Attach additional page if needed for lengthy description OR attach <br /> a copy of the-deed JOR attach tax.system'tp�roopeerty page. <br /> Parcel#(24 digits): Oq — Cib <br /> O 13C1� D z <br /> Tax ID#(1-5 digits):_ ,�t <br /> Property Site Address: V y g+I -TC hV% t1 Lo�Ln_. i��. i� <br /> C <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec3 oU. <br /> Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building + 5- <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 <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway <br /> Proposed Structure/Addition Use: ITCS)'ne- 3 Q �omS Jh¢ - M D rn <br /> (H i /Cabin;Conemerciu!Btrsineae:uew aom;Deck,,etc.) O Irl <br /> ' l �. <br /> BuildingComractor.�� C-",n m MasterPlumber.h10 <<> ? km6l/l `L. zo <br /> Anticipated Start Date: - { Re¢s'� # SIXz rn <br /> �J Page 1 of 4 <br /> Burnett County, WI Land Use Application—Rev 3/2016 ^—� <br />