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LAND USE PERMIT APPLICATION—Burnett County, WI _ ro <br /> H <br /> Permit Fees: $ a <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to DwellinlpPrincipal Build' -Single Family $200 C7 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwellin ci al Building-Multi-Family $200 <br /> CommerciaUlndustrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse $250 ( q <br /> Accessory Structure-Commercial Cl&Il $200 Addition to Accessory Structure-Commercial Cl&Il $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& � <br /> (Screenporches-in campgrounds only) $125 Gazebo WI Stat 59.692 lv $350 r <br /> Camping Unit $100 Fillin Gradin $150 °^ <br /> Permit Extension(Valid for one year-Only l Allowed $100 Boathouse $500 m <br /> w <br /> a <br /> 'NOTE:Ager-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. Q <br /> "Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. r <br /> 0 <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: A L FYYl2lc f N Dk Z we-A P% 1 A/6rEA <br /> Applicant's Mailing Address: 1.S_31 b P,A IA)T-6-45LAu1E �sot AN 53-0c67 b <br /> City State Zip < <br /> o w <br /> Applicant's Telephone Number: i c 12.--JZ8^ <br /> a � <br /> Applicant's Email: CL b:5 w:e a C l 1,3 F 1c, <br /> •! V <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. w t <br /> ❑Letter ❑Phone ❑Email ZS <br /> oa <br /> Legal Description: 5 EE /71 FT d <br /> Lot#: CSM Vol. Pg. OR I <br /> Lot#: Block#: Subdivision Name: OR <br /> I <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: 1 <br /> "Attach additionalpage if needed for lengthy description OR attach a copy of the deed OR attach tax system propenypage.' �( <br /> Parcel#(24 digits): <br /> Z <br /> Tax ID#(1-5 digits): _3 2 <br /> Property Site Address: _feel E'y /C Ppb 5PpOMC k. k3 1 571-801 <br /> s <br /> TYP F PERl4rr(S): Check appropriate box/boxes Fee Rec:3d0 <br /> Single Family Dwelling Ll Multi-Family Dwelling LlFilling/Grading LlCommercial Building <br /> ❑ Single 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 co <br /> C: <br /> M u') <br /> Proposed Structure/Addition Use: L'A 13 i/✓ m <br /> t/N�t �FG Ili (Home/Ca6in;Commercial Business,-Bedroom;Deck;etc.) IVO M <br /> Building Contractorp'-ty yo Z L-P L7o A4STP. wc7,7&✓Master Plumber:,?u.g&)EZ 23M$W!r co Z n <br /> Anticipated Start Date: �—2.0—l!i D C Z rn <br /> Page 1 of 4 --1 �Y <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />