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LAND USE PERMIT APPLICATION — Burnett County, WI a _ b <br /> N ^ <br /> H � <br /> Permit Fees: <br /> 6 <br /> Dwellin rind al Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwellin rind al 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 <br /> Accessory Structure-Commercial Cl &Il) $200 1 Addition to Accessory Structure-Commercial CI &Il) $200 G] <br /> Deck/Stairs/Patio/Retaining WalUSidewalk/Driveway& <br /> (Screen orches-in campgrounds only) $125 Gazebo(WI Stat 59.692(l v)) $350 r <br /> Camping Unit $100 Filling/Grading $150 ° rn <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 Boathouse $500 w 1 v <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> b <br /> *Items not listed above will be treated as accessory structures,such as pergolas, landscaping, etc. <br /> o <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: 16 RA)C-6r Pa CJV\ <br /> Applicant's Mailing Address: f �• 8 3 3 r'v �}tv l3 cJ 12 LO SRf 8'3 o b_ <br /> City State Zip z <br /> o � <br /> c <br /> Applicant's Telephone Number: V45-79/—Opp{ <br /> 0 <br /> Applicant's Email: ! ac'k h roe— �Q l u tv o c-o w, <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter ❑Phone REmail <br /> A 1 <br /> Legal Description: R <br /> m <br /> Lot#: CSM Vol. Pg. OR y <br /> Lot#: Block#: Subdivision Name: OR o <br /> F <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Yle_Town#: 191 N Range#:__L(pW Town of: 3 W t$S <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): b 7 -D 3 Z - 2. -41 ' I to— 3(o— 3 0Z—0610 -co 100 20 <br /> Tax ID#(1-5 digits): 37.3433 <br /> y �' <br /> Property Site Address: Z9 7 99 M I N ff RV A C IR, <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rei : <br /> L3Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading L3Commercial Building <br /> ❑ Single Family Addition ❑ MultieFamily Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs X Acc. Structure(Non-bunkhouse) .O Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) b Camping Unit ❑ Commercial Acc. Addition C <br /> ❑ Boathouse ❑ Screen porch—campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway :0Ul <br /> Z m <br /> / (S� <br /> Proposed Structure/Addition Use: C�f�R.tRGF I <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 0 J �� <br /> �n ZBuilding Contractor: Master Plumber: <br /> Ciiig <br /> Anticipated Start Date: 101ISI Ito No <br /> —1 <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />