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LAND USE PERMIT APPLICATION —Burnett County, WI a _ <br /> Permit Fees: a a <br /> Dwelling/Principal Building-Single Family $300 Addition to DwellinglPrincipal Building-Single Family $200 C7 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaUlndustrial Building $200 p <br /> Accessory Structure(Non-Bunkhouse) g <br /> Addition to Ace.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &11) $200 Addition to Accessory Structure-Commercial Cl &Il $200 <br /> Deck/Stairs/Patio/Retaining WalUSidewalk/Driveway& <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(l v) $350 r <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Permit Extension Valid for one ear-Only 1 Allowed $100 Boathouse $500 <br /> m <br /> 0 <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. a <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. a <br /> Applic t Complete All Sections Below This Line o <br /> Applicant's Name: Y>C) 4iE;__ <br /> 9 <br /> Applicant's Mailing Address: a <br /> pp g �� cS � � LO)QQK LCIN°L SeooNir (/1�, _ � <br /> City IState Zfip <br /> Applicant's Telephone Number: 5 <br /> a � <br /> o <br /> Applicant's Email: LJL (/J q <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N °G t <br /> []Letter ❑Phone WFmail / 1 <br /> Legal Description:(W q , hlV,l SW 4 Solo "156 W VU 4k 03A iJ 4A"#d/x,14 &4--n r{{ ek v <br /> Lot#: CSM Vol. 1.7(p4 Pg. Z 04 OR CVOu q Dec. X33 13Z, r <br /> Lot#: Block#: Subdivision Name: OR F l <br /> Gov't Lot#: OR 1/4 1/4 I I <br /> Section#: It Town#:__13__N Range#: 14 W Town of: IZLa�< �/ y <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): 07- 024 - I- 3R - 14 - 1( -3 - 04 - 000 - 15000 <br /> � z <br /> Tax ID#(1-5 digits): t5 S.ZS <br /> Property Site Address: 26 525 Le jo^ Lety1G t ku3kt&% lik,D, 5nmonfh Uli• <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 /> ❑ Stairs �& Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(iv) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway �1 <br /> 00 <br /> Proposed Structure/Addition Use: S-}p rMyt f _-_SKA�V_ M C___ M <br /> ((Hor /Cabin;Commercial Business,-Bedroom;Deck;etc.) N Z tl�11 <br /> Building Contractor: Cow%;kty ,-.oh Uva,\iwAtA Master Plumber: 'VY A. ZM <br /> Anticipated Start Date: -38hw k.w,N.4OKI { t t �I— Z C) Q <br /> Pagel of 4 Z <br /> Burnett County,WI Land Use Application—Rev 3/2016 Z <br />