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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> in <br /> Permit Fees: ° o� <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 CJ <br /> Dwellin:Princi.al Building-Multi-Famil $300 Addition to Dwellin. 'rinci.al Building -Multi-Famil $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> O <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure Ga I'a ce $150 Bunkhouse $250 co <br /> Accessory Structure-Commercial(C1 &Il) $200 Addition to Accessory Structure-Commercial(C1 &I1) $200 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> (Screen porches-in campgrounds only) $125 Gazebo(WI Stat 59.692(lv)) $350 r, <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 Boathouse $500 cn <br /> A) <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. '1 <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. `• <br /> b <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> 0 <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: £tir* 0 5 vo id <br /> Applicant's Mailing Address: I --, ?g 'r 4- 4 ve. J. 'etU I lki t `� <br /> City Statep C It <br /> e <br /> Applicant's Telephone Number: 1/4175- s's/( o- <br /> Applicant's Email: el l O-f_0.sv01 E74 h©p t C 0 rh ED' <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> ❑Letter ['Phone thmail <br /> Legal Description: Sec I q Tv, 0 R3 17 PCL Gov LoT 3 &Tax) . <br /> Lot#: CSM Vol. Pg. OR ( ' ) 1 <br /> t <br /> Lot#: Block#: Subdivision Name: OR o <br /> F <br /> Gov't Lot#: OR 1/4 1/4 • <br /> ° <br /> Section#: ill Town#: 110 N Range#: /7 W Town of: Ut4 I()h y <br /> *Attach additional page if neededforr'lengtt/hy description OR attach a copy of the deed OR attach tax system property page.* <br /> V <br /> Parcel#(24 digits): 07- -3W-2-y0."'/7-/1 - 057-403 -o39000 i' <br /> q <br /> n z <br /> Tax ID#(1-5 digits): 2 7 8 6 A p' <br /> Property Site Address: tV\ y0{'pc�l reSS, <br /> 1 d v <br /> E OF PERMIT(S): Check appropriate box/boxes Fee Rec '(t(�D� <br /> Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building •It'1C.1l.t[ itS $15ba2 <br /> 777777U,,Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> CieWe0-Stairs CI Acc. Structure(Non-bunkhouse) Li Bunkhouse ❑ Commercial Acc. Structure pp� <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(1v) ❑ Camping Unit CI Commercial Acc. Addition .193W_ ... <br /> ❑ Boathouse ❑ Screen porch—campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway <br /> _..mow. <br /> Proposed Structure/Addition Use: I/04 j a --�t <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) f,, 2 to (5 <br /> Building Contractor: E'//( Ot /J Master Plumber: Urnb I/1 J y J��tJ <br /> �f / yn ®n <br /> rJ / (� <br /> Anticipated StartDate: S— a 1 v c T.,"Page1of4 3 P <br /> • Burnett County, WI Land Use Application—Rev 3/2016 4 �}—]j <br />