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LAND USE PERMIT APPLICATION -Burnett County, WI a <br /> Permit Fees: <br /> DweUm nnci al Building-Single Family $300 Addition to Dwell' ci al Building-Single Family $200 a <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family_ $200 <br /> CommerciaVindustrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Ace.Structure $150 Bunkhouse $250 I <br /> AccessoryStructure-Commercial Cl&I1 $200 Addition to AccessoryStructure-Commercial Cl &Il $200 _ <br /> Deck/Stairs/Patio/ReWning Wall/Sidewalk/Driveway& <br /> (Screen rches-in campgrounds only) $125 Gazebo Wi Stat 59.692(ly) 5350 <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension(Valid for one year-Only 1 Allowed 5100 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. �y <br /> *Items not listed above will be treated as accessory structures,such as:pergolas.landscaping,etc. r <br /> 0 <br /> / Applicant Complete All Sections Below This Line o <br /> Applicant's Name: (,�'yQ� -S 7 L �IA[ �t (� - <br /> Applicant's Mailing Address: 105-011 8AA.D M f Irl C�f�I t-.7 er CtSGAJ, k• ���ys <br /> City State Zip o w <br /> F <br /> Applicant's Telephone Number: <br /> — a <br /> m <br /> Applicant's Email: r,4RC04b. CO <br /> 'n <br /> I <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. 9' °o I <br /> ❑Letter Phone ❑Email <br /> Legal Description: 5 <br /> Lot#: CSM Vol. Pg. 13 I OR u, <br /> 110) <br /> Lot#: Block#: Subdivision Name: OR 0 <br /> Gov't Lot#: OR 1/4 1/4 1 <br /> Section#: Town#: N Range#: W Town of: '� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* i <br /> N <br /> Parcel#(24 digits): 01— a 3 2.— Z•—'4 I -f 5-^09-5- O S--60 2.—61?COO <br /> n z <br /> Tax ID#(1-5 digits): 2 2195 p ,, � <br /> Property Site Address: -3 ( 3®(p rAPi.20 LAKE ,DwM 1 <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:a.00 <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 <br /> ❑ Boathouse ❑ Screen porch—campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway C <br /> \ Z � <br /> �avnaa��� �in1\' NZ c <br /> Proposed Structure/Addition Use: z <br /> (Home/Cabin;Commercial Business;Bedroom;Deck,etcZ.) t�c <br /> 20 <br /> Building Contractor: (anti MR©>z 1 K Master Plumber: <br /> 170 <br /> Anticipated Start Date: jt.t Ly ! 2-(Dl(o Z <br /> Pagel of 4 <br /> Burnett County,WI Land Use Application—Rev 3/2016 �� <br />