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LAND USE PERMIT APPLICATION — Burnett CountyWI r <br /> a c" <br /> y 1 <br /> Permit Fees: °,- <br /> a <br /> DA41ingiflirincipal Building-Single Family $300 Addition to DwellinglPrincipal 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 O <br /> Accessory Structure(Non-Bunkhouse) i f <br /> Addition to Acc.Structure $150 Bunkhouse $250 m° <br /> Accessory Structure-Commercial Cl &11) $200 Addition to Accessory Structure-Commercial CI &I1) $200 ` <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> Screenporches-in campgrounds only) $125 1 Gazebo WI Stat 59.692(lv) $350 r <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Permit Extension Valid for one year-Only I Allowed) $100 Boathouse $500 w <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. ' <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: ly aLQK <br /> 1�1 <br /> Applicant's Mailing Address: -5$( S,0*.S%A Zk*�bola /K/V 55W2- <br /> City <br /> 5W2 City State zip c <br /> Applicant's Telephone Number: <.s o7 <br /> v <br /> Applicant's Email: Q 6 '`�"ho Kpsa.0@60k [O 0+ <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> ❑Letter Phone ❑Email <br /> Legal Description:� _ Al 02,0 A, r?O V A0+ � d <br /> Lot#: CSM Vol. Pg. OR a <br /> Lot#: Block#: Subdivision Name: OR £ o <br /> Gov't Lot#: _OR 1/4 1/4 1 Ul <br /> Section#: _Town#: N Range#:_/ �W Town of: <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): 0�7"Ge10 -2 ^y0*-/to 003 - y /Jo00 <br /> r, z <br /> Tax ID#(1-5 digits): 3q Z-3 z <br /> Property Site Address: 19,U) coft'v t P ,6U&c�r 14 1 <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: mdoci <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs 4eAcc. 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 /> Proposed Structure/Addition Use: GA4-am e, <br /> Irk4 <br /> /Cabin;Commercial Business;Bedroom;Deck;etc.) O M <br /> Building Contractor: �$ k Irk aa.•l3,SD�+ Master Plumber: Z <br /> Z r= <br /> - <br /> tv <br /> Anticipated Start Date: A� is 'LO l�G C `��'� <br /> Page 1 of 4I <br /> Burnett County, WI Land Use Application-Rev 3/2016 {�"-� <br />