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LAND USE PERMIT APPLICATION—Burnett County, WI a <br /> Permit Fees: 0 a <br /> n <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Fa rdl $200 O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 w <br /> m^ <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) £O <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial CI &❑ $200 Addition to Accessory Structure-Commercial Cl &Il $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> Screen orches-in campgrounds only) $125 Gazebo(Wl Stat 59.692 Iv) $350 r <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 Boathouse $500 y <br /> w <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 /> *items not listed above will be treated as accessory structures,such as:pergolas,landsca in , etc. <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: C Ak L i' (3 y S C{4 <br /> Applicant's Mailing Address: 0291ro A C.&e_/J,Z l e kPl _ SpeNr-e/' 0i.. Y� � b <br /> City State zip Z <br /> Applicant's Telephone Number: 7�S'.Z `� — 33 ,`0 a � <br /> Applicant's Email: <br /> ^0 1 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N 0° t <br /> ❑Letter Phone ❑Email ° <br /> Legal Descri tion: {I C �1-o'� Y9, J Or N W r l SiFC: 'U N (Z o <br /> Lot#: CSM Vol. Pg. / q OR T�N � I� Yti/ 1 <br /> Lot#: Block#:— Subdivision Name: OR F <br /> Gov't Lot#: OR A4 `� 773 ° \ <br /> N/. 1/4 Al�VY. 1/4 1 <br /> Section#: Town#: N Range#:—LY _W Town of: 5C0 7--r v <br /> *Attach additional page if neded for lengthy de <br /> —e7 <br /> scriptioonn OR attach a copy of the deed OR attach tax system propertypage. <br /> Parcel#(24 digits): / _b aA a— 1 14—ID— v�O 02— 000 -013000 <br /> j7 n z I <br /> Tax ID#(1-5 digits): I `93 / <br /> /� '54-801( <br /> Property Site Address:_ 261 l 10 M,C k e n z'1 R 4 • CJ�t;r j,(f i . S4"S 0 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes s <br /> 0 <br /> Fee Rec:c <br /> LlSingle Family Dwelling Ll Multi-Family Dwelling LlFilling/Grading LlCommercial 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 /> M n <br /> Proposed Structure/Addition Use: L j L l 1✓ SiOIQAC,G <br /> / m <br /> Home/Cabin;Commercial Business;Bedroom;Dec��c.) M a <br /> Building Contractor: �. Master Plumber: 0 � <br /> s� <br /> O o <br /> Anticipated Start Date: S—((b 2 <br /> Page 4 <br /> Burnett County,WI Land Use Application—Rev 3/2016 � <br />