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LAND USE PERMIT APPLICATION —Burnett County, WI r <br /> a � <br /> a- - <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family 5300 Addition to Dwelling/Principal Building-Single Family $200 1SZa <br /> Dwelling/Principal Budding-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Budding $300 Addition to CommerciaVlndustrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure S150 Bunkhouse 5250 <br /> Accessory Structure-Commercial CI&Il $200 Addition to Accessory Structure-Commercial Cl&Il $200 <br /> Deck/Staus/Patio/Retaining Wall/Sidewalk/Driveway& o \ <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692 lv 5350 r <br /> Camping Unit $100 Filling/Grading 5150 ° <br /> Permit Extension Valid for one ya-Only 1 Allowed $100 Boathouse s500 v <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. ' <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. b <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> 0 <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: •e_L <br /> L,� wt� 9 Q A e K <br /> Applicant's Mailing Address: Y 3 - a K A w A y" A w A 4 ci 0 h hl t u <br /> City State Zip <br /> r Vl <br /> Applicant's Telephone Number: c -�t cy ce 11 t l$ —a©a-/9 41 c <br /> � a <br /> Applicant's Email: ,n A e_ L A e k e 2 G C_c. vs,c-t4 54 <br /> ro <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> []Letter ❑Phone GDE15ail w m <br /> Legal Description: o <br /> Lot#: 'ot CSM Vol.--t_3_pg. 1 ti 7 OR Sly <br /> i <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: 2 OR 1/4 1/4 Ivy 1 <br /> Section#: Town N Range#:_Z'�7W Town of: � W l S y <br /> *Attach addition/page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits): U — O 3 Q- c -f 0,5 Oma 81 b opO <br /> Z <br /> C) <br /> Tax ID#(1-5 digits): I (v�� z <br /> Property Site Address: <br /> 5 <br /> a <br /> TYPE OF PERMIT(S): Chedc appropriate box/boxes 12]p FSA Fee Rei : <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling 10filling/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(ly) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway to <br /> Proposed Structure/Addition Use: <br /> (Home/ bi ; ommercial Busty;Bedroom;Deck-etc..) <br /> Building Contractor: Master Plumber: <br /> v <br /> Anticipated Start Date: 0 0 <br /> Page 1 of:71 T <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />