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LAND USE PERMIT APPLICATION - Burnett County, WIc <br /> 6 <br /> Permit Fees: 0' ' <br /> a <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Family $200 !�Z � <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwellin rinci al Buildin -Multi-Famil $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Ace.Structure $150 Bunkhouse E <br /> $250 <br /> Accessory Structure-Commercial(C1&11) $200 Addition to Accessory Structure-Commercial CI &11) $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& o <br /> (Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(l v) $350 <br /> t— <br /> Cam in Unit $100 Filling/Grading $150 ° <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 Boathouse $500 Cn <br /> m <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. d' <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> 'v <br /> *Items not listed above will be treated as accessoty structures,such as:pergolas,landscaping,etc. r <br /> 0 <br /> 1Applicant Complete All Sections Below This Line o <br /> Applicant's Name:q}� S7-W►�t.� <br /> Applicant's Mailing Address:_ KO J } 3�%V e- j41�9y�Y �� Dcinbw y W i S*n Z) b <br /> City State Zip z <br /> / O y <br /> Applicant's Telephone Number: O o <br /> d <br /> Applicant's Email: �T13oN�IAs( 4G1�►q (� QMaf I -C'OAN <br /> �-- <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. o °� 1 <br /> ❑Letter Phone ❑Email <br /> 5' <br /> 0j Z- <br /> vo <br /> Legal Description: R <br /> N <br /> Lot#: CSM Vol. Pg. ORCn <br /> Lot#: Block#: Subdivision Name: OR 0 1 <br /> Gov't Lot#: OR /VC1/4_ j W 1/4 ° 1 <br /> .� <br /> Section#: I I Town#:ALN Range#:__L(o W Town of: 5W I S 5 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page. <br /> Parcel#(24 digits): O� O3,Z -.� "y 1 —I G' 9 D ' 00c)-o11100 <br /> � z <br /> Tax ID#(1-5 digits): y �' <br /> Property Site Address: g � SkVe Nttill l,jy --j p&A)gvry W( yggSc) <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: o� <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading O Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs 4d 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 Qy <br /> Proposed Structure/Addition Use: gQrd1 q.e cn <br /> ome/Cabin;Commercial Business;Bedroom;Deck;etc.) rn <br /> Building Contractor:St� JC>1t ng-C Master Plumber: q/A Z <br /> Se- <br /> 20 <br /> Anticipated Start Date: /0-10-16 <br /> o c^ <br /> Page 1 of 4 Z <br /> Burnett Count, Wl Land Use Application—Rev 3/2016 ('� <br />