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LAND USE PERMIT APPLICATION—Burnett County, WI C <br /> Permit Fees: g o� <br /> a <br /> Dwelling/Principal Building-Single Family Addition to;welling/Principal Building-Single Family $200 C7 <br /> Dwellin rinci al Building-Multi-Family $300 Addition to Dwellin rinci al Building-Multi-Family $200 ^ <br /> Commercial/Industrial Building $300 Addition to CommerciaUIndustrial Building $200 t v O <br /> Accessory Structure(Non-Bunkhouse) E <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessor <br /> y Structure-Commercial Cl &II $200 Addition to Accessory Structure-Commercial Cl &11) $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& o <br /> (Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692 Iv) $350 <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 Boathouse $500 m <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. 2 <br /> ro <br /> r/tems not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. <br /> Applicant Complete All Sections Below This Line o <br /> / N � <br /> Applicant's Name: .IRF'�D°.a �S fJfi'K/'Ji� at, <br /> /� <br /> Applicant's Mailing Address: /LaPb3 011Aar/ ' J <br /> v City State Zip y <br /> Applicant's Telephone Number: &6• <br /> d <br /> Applicant's Email: h1AS/+ V/LOMIT <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N °° W <br /> ❑Lette- ,Phone ❑Email <br /> Legal Description: 1!rFC"r1400 —S w Ste- YY R <br /> m <br /> Lot#: CSM Vol. OR <br /> rn <br /> Lot#: Block#: Subdivision Name: OR 1 ( � <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: b Town#: �36?_N Range#:_11 _W Town of: L//1 coAW r <br /> c5 I <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* P <br /> Parcel#(24 digits): S <br /> ro <br /> rZ z <br /> Tax ID#(1-5 digits): 10 4 1'I y <br /> Property Site Address: 1 `,err r 999/ <br /> TYPE OF PERMIT(S): Check appropriate box/boxes s <br /> Fee Rec: <br /> 'P 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 co <br /> l <br /> Proposed Structure/Addition Use: i/Cnv Cr A p `1.�was. \3 M D <br /> N "< <br /> (Home/Cabin; mercia iness;Bedroom`;Deck;etc.) {7 Z tV �inl <br /> Building Contractor: '64" ?,Of 50 .•� Master Plumber: .fn,(�e, „v�5 j�vh 2c) N YoY 1 <br /> Anticipated Start Date: �J 3uw%r Z rn <br /> Page 1of4 < MY <br /> S r Burnett County, WI Land Use Application—Rev 3/2016 <br /> L?�S Jv— <br />