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LAND USE PERMIT APPLICATION —Burnett County, WI 2 <br /> Permit Fees: ?� <br /> 6 <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwelling/Principal Building-Multi-Famil $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 p <br /> Accessory Structure(Non-Bunkhouse) E <br /> Addition to Acc.Structure $150 Bunkhouse $250 r'+ <br /> Accessor•Structure-Commercial Cl&Il $ 0 Addition to Accesso Structure-Commercial Cl&I1 $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& < <br /> (Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692 lv $350 <br /> Camping Unit Filling/Grading $150 <br /> Permit Extension(Valid for one year-Onl I Allowed) $100 Boathouse 5500 rn <br /> m <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping, etc. <br /> r <br /> o <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: Sw Aa„ K 2ry.leetJi la l e+ g <br /> Applicant's Mailing Address: 2kf 10 5-4-k Ali V,-6 m Al 3 n o <br /> City State zip <br /> Applicant's Telephone Number: S 0 7 - 27 3- t,1o2- a <br /> i b <br /> Applicant's Email: 1'S F ethKe- yo-k ao • C'0 VVt <br /> -o <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N 0° <br /> ❑Letter XPh ne ®Email 1 p <br /> Legal Description: QCL oV a rY E lh 1 ° <br /> y <br /> f � <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR o' <br /> Gov't Lot#: OR 1/4 1/4 1 <br /> Section#: Town#: N Range#: W Town of: "\ <br /> *Attach additional page ifneeded for lengthy description OR attach a copy of the deed OR attach tax system property page.* l <br /> Parcel#(24 digits): f11- pa R <br /> -2_ `l D -l`�- to ' o S - 00► - 0 25 MD -� <br /> n z <br /> Tax ID#(1-5 digits): <br /> Property Site Address: uT S-Y aft/ <br /> TYPE OF k Ch <br /> 5 PERMIT : Check appropriate box/boxes <br /> � � Fee Rec:LR bao <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ,.❑/Filling/Grading Ll Commercial Building <br /> LJ Single 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 fes` <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retainin Wall ❑ Sidewalk/Driveway <br /> F Nem c <br /> Proposed Structure/Addition Use: RA-F)a-ep— >� d f c�.GGI�-` . "Oen' Z C <br /> 11// (Home/Cabin;Commercial Business:Bedroom;Deck,etc) Z <br /> Building Contractor: Aytd ,,_ V4 a_n%A-,� Master Plumber: <br /> o Q <br /> Anticipated Start Date:���_ Z 2jn l6Z 2�d!6 o_ <br /> Page 1 of 4 Z <br /> Burnett County, WI Land Use Application—Rev 3/2016 Z C�— <br />