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LAND USE PERMIT APPLICATION—Burnett County,WI g b <br /> Permit Fees: °or ryall <br /> Dwelling/Principal Building-Single Family 5300 Addition to DwellinWPrincipal Building-Single Family $200 a <br /> Dwelling/Principal Buil -Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Famil r$2Commercial/Industrial Buildin $300 Addition to Commercial/Industrial Buildin Accessory Structure(Non-Bunkhouse) <br /> Addition to Arc.Structure $150 Bunkhouse Access Structure-Commercial C 1&II 5200 Addition to Acce Structure-Commercial C I&Il Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway&Screen rches-in cam ounds onl 5125 Gazebo Stat 59.692 lv r, <br /> Camping Unit $100 Filling/Grading Filling/Grading5150 ° <br /> Permit Extension Valid for one year-Onl IAllowed 5100 Boathouse $500 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up Io three times the normal fee. ' <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. , ro <br /> *Uems not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Applicant Complete All Sections Below This LineIZI <br /> " o <br /> Applicant's Name: 11L14 5'_ .�Q n t_�Q c 2✓ <br /> Applicant's Mailing Address: -2%5? 2jaT5-/4 <br /> City State Zip c <br /> Applicant's Telephone Number: 4(„1 Z to`70 J( SCh <br /> 0 <br /> Applicant's Email: r rj c tt P r tT_ ,zi ca I . ( c city. <br /> ^o <br /> if staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter ®Phone ❑Email <br /> Legal Description:�tAd ice,,�. rde=1 Cet"^ LI at_%4 -42 r <br /> Lot#: CSM Vol. Pg. OR a 1 <br /> Lot#: Block#: Subdivision Name: OR o <br /> Gov't Lot#: OR 1/4 1/4 l 1 <br /> Section#: Town#: N Range#: W Town of: SGS <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> r <br /> Parcel#(24 digits): 6`7, 02�i+-- 2 - Sl p . 1 S/ - 2 3 - 5-- /L -IL T- d 12 c3o n � <br /> n z <br /> Tax ID#(1-5 digits): kQ 4 <br /> Property Site Address: l2$U Co«tnjLi 'QU F '4rOz�xtner t. Z <br /> C <br /> TYPE OF PERMIT(S):Chedt appropriate box/boxes FeeRec<2G <br /> id Single Family Dwelling L3 Multi-Family Dwelling ❑Filing/Grading ❑Commercial Building <br /> Single Family Addition 13 Multi-Family Addition Ci Deck/Patio LJCommercial Addition <br /> LJStairs L3Acc.Structure(Non-bunkhouse) ❑Bunkhouse LICommercial Aa.Structure <br /> L3Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑Camping Unit ❑Commercial Aa.Addition <br /> L3Boathouse LlScreen porch-campgrounds only LIRetaining Wall Llwal SideDriveway <br /> Proposed Structure/AdditionUse: aJ p4Q <br /> ,H—<V Commercial Busmess;Bedroom;Deck,etc.) to ✓L <br /> Building Contractor: Q�Cr�f! F Er�lct Master Plumber: M <br /> Anticipated Start Date: __ O m Z <br /> Page 1 of 4 Z to <br /> Burnett County,WI Land Use Application—Rev 3/2016 Z n eo 0 <br /> �o <br /> Z �' rV <br />