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LAND USE PERMIT APPLICATION —Burnett County, WI a b <br /> N I1r�,\.j11 y <br /> Permit Fees: a ?� <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Famil $200 C7 <br /> DwellingfPrincipal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Famil $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) F <br /> Addition to Acc.Structure $150 Bunkhouse $250 1 <br /> Accessory Structure-Commercial Cl&Il $200 1 Addition to Accessory Structure-Commercial CI &11) $200 <br /> G7 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(l v)) $350 S <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 Boathouse $500 <br /> w <br /> 0 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. ;»' <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. `d <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landsca h; ,etc. <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: T49) h A$ M• OL 50 i✓ <br /> Applicant's Mailing Address: 2-19$13 L o o e P% 116 Rd W a k of V; SIAPM 9 <br /> City State Zip -e <br /> C> <br /> Applicant's Telephone Number: `j 12- L{Z 3- <br /> ff y✓ d <br /> Applicant's Email: 01'IG1�S'leW 404 . GDM io <br /> b <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N °° 1 <br /> []Letter gphone ❑Email <br /> Legal Description: Nu/y'f N6 II*f Sect/oA 1.9 Tow►+skrp y4 /?q Pt <br /> N <br /> A <br /> Lot#: CSM Vol. 1/ Z Pg. Z07 OR a, <br /> Lot#: Block#: Subdivision Name: OR o <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional page ifneeded for lengthy description OR attach a copy of the deed OR attach tax system property page.* ]'- <br /> Parcel#(24 digits): 07' 0 Z O• Z-140-14-L9 -5 OSte-001 -01)i0C0 S <br /> A <br /> Z C9 <br /> Tax ID#(1-5 digits): 139/9 p h <br /> Property Site Address: 71 7 9$3 L D IV& Fl NG 1�d <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs A Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition to 1 � <br /> L3 Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall LISidewalk/Driveway C �- J��('''�'JI <br /> Proposed Structure/Addition Use: Cj 9 rA[)e. T C <br /> (H a/Cabin;Commercial Business;Bedroom;/Deck;etc.) -�•+j Z <br /> Building Contractor: s2 Master Plumber: x ,4 bZ <br /> FUR <br /> Q ra <br /> Anticipated Start Date: �� 1� C <br /> Page 1 of ;11 <br /> Burnett County,WI Land Use Application—Rev 3/2016 -C <br />