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10 1711 <br /> LAND USE PERMIT APPLICATION- Burnett County, WI <br /> Permit Fees: °_ 9 <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single FamilyCL <br /> $200 <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwelling/Principal Building-Multi-Famil $200 K <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structur"on-Bunkhouse) 0 <br /> Addition to Acc.Structure $150 Bunkhouse $250 M <br /> Accessory Structure-Commercial Cl&I1) $200 Addition to AccessoryStructure-Commercial(Cl&Il) $200 G) t l <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> (Screen orches-in campgrounds only) $125 Gazebo(WI Stat 59.692(ly)) $350 <br /> Camping Unit $100 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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. <br /> 0 m <br /> Applicant Complete All Sections Below This Line 0 1� <br /> Applicant's Name: , <br /> Applicant's Mailing Address:e zI� �O /-/.S c, /` 4. .4 "LsM <br /> JJ'/ / City 7` State zip <br /> Applicant's Telephone Number:AR no lSp Xn3 33 a) /) �/,�) gq, -IVY o a t <br /> d 71 <br /> Applicant's Email: IU M rNl pTj� <br /> y <br /> 1 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> []Letter 'Phone [Email ° <br /> w <br /> Legal Description: &Atof t h/ Lw�i-t h w r t Que,,• e o "fly� Nee`ytN,04-y - (4u a4jr/ <br /> Lot#: CSM Vol. Pg. OR I <br /> Lot#: Block#: Subdivision Name: OR o <br /> Gov't Lot#: OR 1/4 1/4 I <br /> Section#: ej-3 Town#:__4_L_N Range#:_,/_(W Town of: S rut? a - <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* / <br /> Parcel#(24 digits): ©�) 0 ,1&- al ^ 41 16-a3- /-O eL-UQO - d 17 0 O O <br /> ' z G <br /> n <br /> Tax ID#(1-5 digits):_ p T <br /> Property Site Address: 3 0 7 �� P l k L P_6 u n! ti/ ,W+ Sy83 a ' <br /> h IIS" <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:15� <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <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 Wall ❑ Sidewalk/Driveway <br /> Proposed Structure/Addition Use: N1,0 ftNjV Q1at,t/ C <br /> (Name/Cabin;Commercial Business;Bedroom;Deck, etc) 3 C <br /> Building Contractor: 1c4 A4 Il d 0..,.. Master Plumber: � m � <br /> Anticipated Start Date: 7- p '/� _ -� Z 0 <br /> 20 V <br /> Page 1 of 4 c C_ <br /> Burnett County,WI Land Use Application -Rev 3/2016 Z rn <br />