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LAND USE PERMIT APPLICATION —Burnett County, WI <br /> Permit Fees: g C cis <br /> Dwelling/Principal Building-Single Family $300 Addition to DwellinglPrincipal Building-Single Family $200 G <br /> Dwelling/Principal Building-Multi-Family $300 Addition to DwcfiingfPrincipal Building-Multi-Family $200 1111IITIII�" <br /> CommerciaUlndustrial Building5300 Addition to CommerciaVlndustrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Ace.Structure $150 Bunkhouse $250 ; <br /> Accessory Structure-Commercial C l&I l $200 Addition to Accessory Structure-Commercial C l &11) $200 <br /> G1 S <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& G <br /> (Screen rches-in campgrounds only) $125 Gazebo WI Stat 59.692(1 v $350 <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension(Valid for one year-OnlyI 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. o <br /> *Items not listed above will he treated as accessory structures,such as:pergolas,landscaping,etc. <br /> / Applicant omplete All Sections Below This Line <br /> r a ,�vl�s� <br /> Applicant's Name: Vs^ t _'`_ <br /> Applicant's Mailing Address: r�C� /�� eq �,dc L1 Lira LA4,S 0 b <br /> City State Zip o � <br /> Applicant's Telephone Number: <br /> n <br /> \/ a <br /> Applicant's Email: <br /> �1 r°'4 U cm� (X Its. rv+ <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. o tl0 <br /> ` / Letter %Phone ,mail, <br /> Legal Description: Lbs C S M �Z� 1`7 <br /> Lot#:�_CSM Vol. Pg. OR a, <br /> Lot#: ( Block#: Subdivision Name: OR IQ <br /> Gov't Lot#: OR 1/4 1/4 / /, <br /> Section#: Town#: N Range#: W Town of: �/�>✓ �M 1(,- <br /> *Attach additional page if needed or lengthy descryytp��tio}n�OR it has py of the deed OR attach tax system property page.* W <br /> Parcel#(24 digits): l�G 1-7 I l4 /I�D'�3 yz 3 7 1W Z-0 00101-//0 0 <br /> Z G <br /> Tax ID#(1-5 digits): pp � <br /> Property Site Address: I 17[�� .t/1 /'. t/an;61c, <br /> a <br /> TYPE OF PERMIT(S): Check appropriate box/boxes <br /> Fee Rec: G-00 CC) <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑Single Family Addition ❑ Multi-Family Addition )i(Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs ❑ Acc.Structure(Non-bunkhouse) )643unkhouse ❑ Commercial Acc.Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ /Rettaining Wall ElSidewalk/Driveway <br /> Proposed Structure/Addition Use: U!Ct C�tL 1--r t / gan 46C <br /> (� (Home/ in;C&nmercial Business;Bedroom;Deck,etc.) NZ <br /> Building Contractor: Cl LVA kf Master Plumber: Z <br /> Anticipated Start Date: I Iar'11 Z O C=D <br /> t=a <br /> Page 1 of 4 C <br /> Burnett County, WI Land Use Application—Rev 3/2016 <br />