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LA1VU UAL' YLSIdIVIl 1 AYYL1l A 1 lU1V — Burnett t ounri, Wil - C <br /> Permit Fees: <br /> Dwelling�Princi pal Building-Single Family 5300 Addition to IhvellinePrincipal Building-Sin le Famih 5200 <br /> Dvelling Princi al Building-Multi-Family 5300 Addition to Dwelling Princi pal Building-Multi-Family S200 <br /> Commercial/Industrial Building 5300 Addition to Commercial,Industrial Building 5200 j IV <br /> Accessory Sttucture(Non-Bunkhousc) <br /> Addition to Acc.Structure 5150 Bunkhouse S250 <br /> Accessory Structure-Commercial(CI &I l) 200 Addition toAccesson Structure-Conuncrcial(CI &11) S200 <br /> Deck/Stairs%Patio Retaining Wall'Sidervalk Driverva) & <br /> (Screen orches-in campgrounds onh') 125 ,azebo(WI Stat 59.692(l% 5350 _ <br /> Camping Unit 00 Filling Gradin_ 5150 _ <br /> Permit Extension(Valid for one year-Oniv I Allowed) S100 Boathouse S500 :9 <br /> *NOTE:After-tire-tact(when no permit is obtained prior to construction)is up to three times the normal fee. ' <br /> *Communication Towers K Sins require a dijj�r•ent application.%int,see corresponding application mrd fees. _ <br /> ^J <br /> *Items not listed above will be treated as accessoiv snverures,such as:peiyolas, landscaping, etc. <br /> o - <br /> Applicant Complete All Sections \Below This Line <br /> Applicant's Name: `�, I //,,��,,,�� ^fly ' '�•�_ , <br /> Applicant's Mailing Address:-2(019 oja4- �V\� f J"V. 6 A/� <br /> Citi' State Zip <br /> Applicants Telephone Number: � <br /> Applicants Ernail: S L ��13 t� 0-0-J �m <br /> If staff has a question about this application homy do you prefer to be contacted? Check one below. ?' <br /> ❑Letter _❑Phone Email ''/'^ m <br /> Legal Description: 31 5 ��n h�t`�>(. C� d <br /> Lot#: 3 CSM Vol. _Pg. L fi} OR ALJ <br /> Lot#: Block#: Subdivision Name: OR <br /> ) <br /> I <br /> Gov't Lot#: OR 1/-1 1/-I i ` <br /> Section#: Town#: N Range#: W ToN%n of: l (� <br /> 7�(J� <br /> lttach addilioud page r'/needed,/or lengtJty desciipti/oJnO\\R ntrcnch n copt,ojthe deed OR{attach tea systeni7property page.* <br /> Parcel#(24 digits): <br /> r Z <br /> I <br /> 3���' <br /> Tax ID#(1-5 digits): �ozc)) <br /> Propert} Site Address: <br /> Z(?)0 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:_ vc <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building (�yq _ r <br /> ❑ Single Family Addition ❑ Multi-Family Addition Deck/Patio El Commercial Commercial Addition r iE) <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 <br /> ❑ Boathouse ❑ Screen porch—campgrounds only ❑ Retaining Wallr ❑ Side/w�alk/Drivew�ayr C <br /> SO <br /> Propose Structure/Addition Use: n <br /> C <br /> H me'Cnbin:Cana er• iof Basin Bedroq+'u:Deck:etc) Z ITI r� <br /> Ch 11 c A _—'{I W <br /> rye! ' <br /> PH <br /> Building Contactor: � ��`r � aster umBer: � �'"" Z 0 1.-. o <br /> Anticipated Start Date: L Q 'n ocigg <br /> 113 Page 1 of 4 Z <br /> Burnett County,WI Land Use Application—Rev 3/2016 4 �1 <br />