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LAND USE PERMIT APPLICATION — Burnett County, WI g <br /> m ^ ' <br /> Permit Fees: c -+ <br /> n <br /> Dwelling/Principal Building-Sin a Family $300 Addition to Dwellin rind al Building-Single Famil $200 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 a <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) ` <br /> Addition to Acc.Structure $150 Bunkhouse $ <br /> 250 <br /> Accessory Structure-Commercial cc]&I l $200 1 Addition to Accessory Structure-Commercial(CI&I1 $200 <br /> Deck/StairsiPatio/Retaining Wall/Sidewalk/Driveway& c <br /> Screen orches-in campgrounds only) �- <br /> $125 Gazebo Stat 59.692 lv $350 ^ <br /> Cam in Unit $100 Filen Gradin <br /> $150 <br /> Permit Extension Valid for one year-Only I Allowed $100 Boathouse $500 a <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. <br /> *Communication Tower &Signs require a dif,jerent application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,latuiscaping,etc. <br /> o <br /> Applicant Complete All Sections Below This Line c <br /> Applicant's Name:_M j C ho e I E L La.t 4-ya E. M e L0.uA k h r1 <br /> v <br /> Applicant's Mailing Address: j)q D w e 4-4lxe r P— cI R C Qct "t? uyt7/J¢ab Q1. oil Syuq <br /> City rr State Zip <br /> Applicant's Telephone Number: 7/S 8 t'o 136 87 c <br /> 1 a <br /> Applicant's Email: Q USfu 1luS C�LL[YY �►E/ <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N 1 <br /> ❑Letter ❑Phone ®Email d <br /> 5' <br /> Legal Description: S t=r=- A r[WCt-lt E-)S G <br /> Lot#: CSM Vol. Pg. OR <br /> v, t <br /> Lot#: Block#: Subdivision Name: OR I o <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: y <br /> *Attach additional page ifneeded for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> r <br /> Parcel#(24 digits): <br /> Z <br /> Tax ID#(1-5 digits): 13 O T Q <br /> Property Site Address: ZCI C)(QS STA'FC-- /}Z I;i3X`r" i L J -j �,3e� <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: o <br /> LJ Single Family Dwelling Ll Multi-Family Dwelling LlFilling/Grading Ll Commercial Building <br /> co <br /> ❑ Single Family Addition ❑ Muld-Family Addition ❑ Deck/Pabo L3 Commercial Addition <br /> Ll Stairs R�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 /> to <br /> N m o <br /> Proposed Structure/Addition Use: 5-4p(,ZQ1cn C � <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc) Z t� <br /> Building Contractor:C LJ66 �6J11-V�iN)G'S Master Plumber: N(A <br /> Anticipated Start Date: 1 C4 1 p 1(p rn � <br /> Page 4 <br /> Burnett County,WI Land Use Application—Rev 3/2016 `vJ <br />