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LAND USE PERMIT APPLICATION - Burnett County, WI a _ b <br /> H rn F+ <br /> Permit Fees: <br /> a <br /> DvvellingtPrincipal Building-Single Family 5300 Addition to Dwell in incl al Building-Single Family $200 = 0 <br /> Dwelling/Principal Building-Multi-Family 5300 Addition to Dwelling/Principal Building-Multi-Family $200 ��^, <br /> Commercial/Industrial Building 5300 Addition to Commercial/Industrial Building $200 V p <br /> Accessory Structure(Non-Bunkhouse) £� <br /> Addition to Acc.Structure S150 Bunkhouse 5250 <br /> Accessory Structure-Commercial(Cl&Il) $200 Addition to Accessory Structure-Commercial Cl&11 5200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& °< <br /> Screen rches-in campgrounds only) $125 Gazebo(WI Stat 59.692(Iv)) 5350 <br /> Camping Unit SI00 Filling/Gradin $150 <br /> Permit Extension(Valid for one year-On IAllowed) $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. D <br /> *Items not listed above will be treated as accessory structures.such as:pergolas.landscaping,etc. <br /> r _ <br /> o - <br /> Applicant Complete All Sections Below This Line Z <br /> n / 1 �j <br /> Applicant's Name: R06 EztD/Beth �IDIy//r/�� 1 !� y� <br /> Applicant's Mailing Address: 15/60 December Cl . /')y_SeMOUn-� / /ri 5506 3 c <br /> City State Zip o _ <br /> Applicant's Telephone Number: 651 _3111- 7A17 <br /> Applicant's Email: 6r'aminer 0 c- fur f'e✓ -ne t <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. p0 <br /> Letter [hone ❑Email s <br /> 00 <br /> 14 <br /> Legal Description: <br /> y <br /> Lot#: // CSM vol. /S Pg. �I 30 OR s <br /> Lot#: Block#: Subdivision Name: OR o <br /> Gov't Lot#: OR 1/4 1/4 '/ <br /> Section 4:3 J3 Town#: y(� N Range#:�W Town of: Ou /t land i <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): 07 C)„)O - a- '/0 16 3 5 ".5 05 -UVJ Q 1000 � <br /> Z <br /> Tax ID#(1-5 digits): 410 I // �J A SU <br /> Property Site Address: 0 7 3 <br /> 7 6 Devi/ S L4/G e Cl <br /> R <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Feel Rec: � d 0_0 <br /> Single Family Dwelling LJ Multi-Family Dwelling ❑ Filling/Grading LlCommercial 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-campgroundsonly LI Retaining Wall LJSidewalk/Driveway <br /> Proposed Structure/Addition Use: /%3 to e—/LCj- C,/ ✓L <br /> p <br /> (Hom /Cabin,'Commercidus <br /> ) Business:Bedroom,Deck etc.) c= <br /> �J /_ N Z � <br /> Building Contractor: r�! S.f re / <br /> ;j /'1 e _ Master Plumber: p l G /l S iolu /&r jZ �, <br /> Anticipated Start Date: 7 / 5 - /6 J 20 <br /> Pagel of 4 )0 c <br /> Burnett County,Wl Land Use Application—Rev 3/2016 1 <br />