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LAND USE PERMIT APPLICATION —Burnett County WI g _ <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 = O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Indusuial Building $200 <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &Il $200 Addition to Accessory Structure-Commercial(Cl&I1 $200 a <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> (Screenporches-in campgrounds only) $125 Gazebo WI Stat59.692(lv)) $350 <br /> Camping Unit 1 $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only I Allowed) 1 $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. <br /> -o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. S <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: EIQietq 1LC KRAa L I A](--.,Applicant's Mailing Address: '`1 5 70 AMR-S ZANE 54VJC-,-4 /QA) 5537 3 v <br /> City State Zip z <br /> T �pg O y <br /> Applicant's Telephone Number: b/ a-Lf6o - Z °Xs <br /> Applicant's Email: KR-Ai-1 G,�f AIW Fi 1-I Al <br /> o <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N "0 <br /> 1, ❑Letter/ one mail <br /> Legal Description: AA h!. '' o&1 L-AKA '5/16 ES IwTS / 7 "t �f °• <br /> Lot#: CSM VOL Pg. OR g' W <br /> Lot#: Block#: Subdivision Name: OR L <br /> Gov't Lot#: OR 1/4 1/4 l �` <br /> Section#: Town#: 01W N Range#: W Town ofU�- <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): <br /> � z <br /> Tax ID#(1-5 digits): 1 Rci ZA, y a <br /> Property Site Address:,,2qe�qJ 9 Ab15Ctej I-AKE ROAD WEOOIA�g ta,t � <br /> a <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:��e� <br /> ❑Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑Commercial Building <br /> ❑ Single Family Addition ❑ MIti Family Addition ❑ Deck/Patio L3 Commercial Addition <br /> ❑ Stairs ®'Acc.Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(iv) ❑Camping Unit ❑ Commercial Acc.Addition <br /> ❑ Boathouse ❑ Screen porch-campgrounds only LJ Retaining Wall ❑ Sidewalk/Driveway C �� <br /> Proposed Structure/Addition Use: 01,44e ?� M <br /> �C-- <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) N Z C <br /> '/ M Z <br /> Building Contractor: T Master Plumber: N j� Z �B- <br /> Anticipated Start Date:_ T � O o � <br /> Pagel of 4 Z rn <br /> Burnett County,WI Land Use Application—Rev 3/2016 Z �� <br />