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LAND USE PERMIT APPLICATION—Burnett County, WI g b <br /> m I� <br /> Permit Fees: a <br /> CL <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Budding-Sin le Family $200 a C7 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercialdridustrial Building $300 Addition to Commercial/Industrial Building $200 v O <br /> Accessory Stmcture(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial CI&I1 $200 Addition to Accessory Structure-Commercial C1 &11) $200 0 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& �1 <br /> (Screenporches-in campgrounds on y) $125 Gazebo(WI Stat 59.692(lv)) $350 t, S <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. w' <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. Q <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. c n J <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: r' NAP =MG?ME CCLAM LAKE NdSP,-rAtt-rY(att_oyP) <br /> Applicant's Mailing Address: to o c( I 5—7A-7­E RD 70 S 121=r.) l wz Sy87Z <br /> City State zip < ,� <br /> 0 y <br /> Applicant's Telephone Number: ?_(,Z -3q9 - b 7Z 7 g <br /> d ' <br /> Applicant's Email: Cf L5 3,1 6e yet tiao . c-oto-. <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N o0 <br /> ❑Letter [2Phone 2tmail �-, <br /> w <br /> Legal Description: o <br /> N <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR o <br /> Gov't Lot#: OR 1/4 1/4 <br /> l <br /> Section#: Town#: N Range#: W Town of: `t <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> r <br /> Parcel#(24 digits): ) <br /> Tax ID#(1-5 digits): 12 7(03 z <br /> d <br /> Property Site Address: �(0�9 STYE lZD 76 G <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: � <br /> LlSingle Family Dwelling L3 Multi-Family Dwelling LlFilling/Grading LlCommercial Building <br /> ❑ Single Family Addition L3.Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs `RL Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ecommercial Acc. Structure <br /> LJ Permit Extension /❑_Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway <br /> Proposed Structure/AdditionUse: TIKI gAf� d PAT1p ExPAtuStolJ�V � IS�t� 1�0e5 NZ <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc`.) —� z ••_ <br /> Building Contractor: Master Plumber: Z 0 cs, G <br /> Anticipated Start Date:_ fo� E2 <br /> C cn <br /> Page 1 of 4 Z <br /> Burnett County,WI Land Use Application—Rev 3/2016 0 <br />