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LAND USE PERMIT APPLICATION—Burnett County, WI P <br /> v+ y p+ <br /> Permit Fees: $ a <br /> a <br /> Dwelling/Principal Building-Sin le Family $3 Addition to Dwelling/Principal Building-Sin le Family $200 tJ> O O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 (1' <br /> Commercial/Industrial Building $300 Addition to Commercial/industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse S250 <br /> Accessory Structure-Commercial Cl&I I $200 Addition to Accessory Structure-Commercial Cl&I l $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> Screenporches-in campgrounds only) $125 1 Gazebo I Stat 59.692 lv $350 4 <br /> Camping Unit I $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 Boathouse $500 <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 /> o - <br /> Applicant Complete All Sections Below This Line z <br /> Applicant's Name: L 0 y%/ ,tl�t?T e- %be vN {� L <br /> Applicant's Mailing Address: 2 �� t�� 01� 1 6&A RM Wl IW2573 <br /> \ City State Zip y <br /> Applicant's Telephone Number: 2 l 2- ' ES4 Igg'I' a <br /> LL d <br /> Applicant's Email: �Owt Tr e �t� r1 q ?� I(Q � Mat'i I - (-a"N <br /> Zs <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N p0 <br /> ❑Letter hone ❑Email =' <br /> 777"' Cr <br /> Legal Description: ST �d]D PI NL I1Lfsm!= SuiLDI V LOj -7 3 Iri 4- <br /> 4 <br /> Lot#: CSM Vol. Pg. OR a <br /> Lot#: ,— Block#: 4' Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 1 <br /> Section#:-k5___'Town#: 40 N Range#: 14- W Town of: S C o� - <br /> *Attach additional page t'fneeded for lengthy description OR attach a copy ofthe deed OR attach tar system property page. <br /> Parcel#(24 digits): © 1 -b Z S 'Z - Q - 4 iDD Tax ID#(1-5 digits):Property Site Address:_ �OS� r t r V_ ` tt aj,TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec <br /> �,Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ['i Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs Acc.Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> E Permit Extension C Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> ❑ Boathouse ❑ Screen porch-campgrounds only E Retaining Wall ❑ Sidewalk/Driveway CD <br /> Proposed Structure/Addition Use:_L+0 IM C Comm <br /> (� (Home/Cabin;Conercial Business;Bedroom;Deck;etc.) N Z ,� E f � <br /> Building Contractor:? -Cy�c�(r1 (A(AC Master Plumber:DG►h rGV.�_� CA V lV t !w U <br /> Anticipated Start Date: 0-701 / % �p ZZo <br /> O G <br /> Page 1 of 4 0 o <br /> Burnett County,WI Land Use Application—Rev 3/201.6 K �j <br />