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LAINL UJE rhIMI1 AYYLIUA 1 WIN - 15urnett t-ounty, W1 <br /> y ~ <br /> Permit Fees: r O1 <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> DwellingtPrincipal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $2000 <br /> Commercial/Industrial Building $300 Addition to Commercial/industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) Q <br /> Addition to Ace.Structure $150 Bunkhouse $250 1 <br /> Accessory Structure-Commercial C 1&11 $200 Addition to Accessory Structure-Commercial C 1&I l $200 ;1 <br /> Deck/Stairs/Patio/ReWning Wall/Sidewalk/Driveway& <br /> Screenporches-in campgrounds only) $125 Gazebo WI Stat 59.692 lv $350 <br /> Camping Unit $100 Fillip Gradin $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 Boathouse $500 <br /> g <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. d <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: l t 'm A-5 Q_2; &T_ <br /> Applicant's Mailing Address: kYCA� its <br /> City State zip c <br /> t r � y <br /> Applicant's Telephone Number: ��� -[77-7- U4691 <br /> d <br /> Applicant's Email: -rt�'v1��2�1"t� '?ly t-foo Cm-,% <br /> b ' <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N 1 <br /> []Letter hone ❑Email 5' <br /> Legal Description: 1W*rPAi0T `t1fP MVA 90keI3Ey4% SFt'W d <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR 90 1 <br /> Gov't Lot#: OR 1/41/4 1 I� <br /> Section#: 26 Town#: �341 N Range#: t W Town of: f2u-44 y <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): VtoWfkar091ko 6-7- 07A- 2 - 39- U- -V-z -`} 01 -Ooo- O t 1000 <br /> z <br /> Tax ID#(1-5 digits): Ly x <br /> Property Site Address: 1 co <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> Single Family Addition ❑ Multi-Family Addition �S 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 03 <br /> r <br /> ,� ��� <br /> Proposed Structure/Addition Use: q, �"p'�`'�� s1 w,�h rosr. Z Z m ^ <br /> (Ain;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: 41 ttT K) Master Plumber: Z 0 `o C== <br /> Anticipated Start Date: Oar 17, Znt(o '�C m <br /> Page 1 of 4 Z <br /> VIM <br /> Burnett County,WI Land Use Application—Rev 3/2016 :� [� <br />