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LAND USE PERMIT APPLICATION—Burnett County. WI g <br /> < - b <br /> Permit Fees: ' a <br /> Dwelling/Principal Budding-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 ' <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwellingd3rincipal Building-Multi-Family $200 <br /> CommerciaUlndustrial Building $300 Addition to Commerciat%dustrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Ace.Structure $150 Bunkbouse $250 <br /> Accessory Structure-Commercial Cl&11 $200 Addition to Accessory Structure-Commercial(Cl&11) $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> Screenporches-in campgrounds only) $125 Gazebo 1 Stat 59.692 lv $350 S r <br /> Camping Unit $100 Filling/Grading Filling/Grading $150 ° <br /> Permit Extension Valid for one year-Only I Allowed $100 Boathouse $500 <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. ti <br /> *items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. <br /> s <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: TA oA"K J f Ga S 7--e//a <br /> Applicant's Mailing Address: r7�'`IT �o/y/�/S�7" /� %W/'f F46N SSS/ <br /> City State Zip o <br /> Applicant's Telephone Number: 6S-(— 17 O '-' -7/ O 2 B <br /> b <br /> Applicant's Email: f c 0-5 re- 9 OF <br /> If staff has a question about this application how do youp fer to be contacted? Check one below. N <br /> 0 <br /> ❑Letter EjKone ❑Email <br /> Legal Description: v <br /> Lot#:, E S4 CSM Vo1.--/Z—Pg. 7 OR s n <br /> Lot#: Block#: Subdivision Name: OR �•1 <br /> Gov't Lot#: OR 1/4 1/4 ` <br /> Section#: 7 Town#: � N Range#: W Town of: Sc o r r °p-� <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system property page.* O <br /> Parcel#(24 digits): D 7 O X4 D �-�Q-/8`-BS= 0 0.3-- 0/3 0 o es <br /> � z <br /> Tax ID#(1-5 digits): /B/ 17 <br /> Property Site Address: ri21g 3 y 81 P-C-4 /3 L4N/, L 4 ke �•� 'fit <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:cRv 00 <br /> ❑ Wgle Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> IYSingle 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 <br /> Proposed Structure/Addition Use: 644 17-/7- ;em Fffgm <br /> ome/Cabin;Commercial Business;Bedroom,Deck;etc.) ^1 m � <br /> lV eeeoe l-6iiC�/!�� EsCgvterPlum g <br /> Building Contractor: C7/S6/✓ Master Plumber: z -i <br /> .Se Z0 <br /> ru � <br /> Anticipated Start Date: /� 0'�4�� Gil O ca ��- <br /> C i <br /> Page 1 of 4 Z <br /> Burnett County, WI Land Use Application—Rev 3/2016 : - <br />