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171 <br /> LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> Permit Fees: 4r V, <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 �7, O <br /> Dwellin Princi al Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> rn <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse $250 °m <br /> Accessory Structure-Commercial CI &11 $200 Addition to Accessory Structure-Commercial CI &11) $200 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(l v)) $350 S <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 Boathouse $500 <br /> w <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 /> *Items not listed above will be treated as accessory structures,such as: er olas,landscaping, etc. T <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: c>7E�-N � 'JO IJ NS.�N <br /> Applicant's Mailing Address: 5� k-I�V r--M "A-e— RD 1WAV.2Y VA 54630 � b <br /> City State zip c <br /> c <br /> Applicant's Telephone Number: X715 �a�o -32L3� _ a <br /> v <br /> Applicant's Email: J1•d��1J`.51�-`+<E�'P���124t A.&I t_.. cz ' == d <br /> ro <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter Phone []Email <br /> do <br /> Legal Description: <br /> h <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR f <br /> Gov't Lot#: r'— OR 1A 1/4 <br /> Section#: 2— Town#: N Range W Town of: 001\1CLAUJga , <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): u,l <br /> Z <br /> Tax ID#(1-5 digits): y �' <br /> O <br /> Property Site Address: t!.. ,b HA--tQ� L ot,-Kz Rf7 bA)-)j i,AKY <br /> s <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 ❑ Deck/Patio ❑ Commercial Addition <br /> Cl Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure G--� <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition Q <br /> ❑ Boathouse ❑ Screen porch—campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway <br /> D <br /> c <br /> Proposed Structure/Addition Use: -a 1 u N N t� <br /> (Nome/Cabin;Commercial Business;Bedroom;Deck;etc.J Z� <br /> Building Contractor:cS ( Pates Master Plumber: Z8 <br /> o <br /> ig <br /> Anticipated Start Date: 9/ I t d a' <br /> Page of 4 <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />