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LAND USE PERMIT APPLICATION—Burnett County WI g <br /> Permit Fees: o' y <br /> e J <br /> Dwellin i al Building-Sin a Family 5300 1 Addition to DwellingftncipalBuilding-Single Farm $200 <br /> Dwellin nci al Build' -Multi-Family $300 Addition to DwellinWPrincipal Building-Multi-Family $200 S <br /> CommerciaVlndustrial Budding 5300 Addition to Commercial/Industrial Budding $200 <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Ace.Structure $150 Bunkhouse $240 <br /> Accessory Structure-Commercial Cl&11 S200 Addition toAccesso Structure-Commercial(C I &I I) $2U0 Od Q <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> Screenporches-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 1 Boathouse S5011 yr <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 /> *hems not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> n <br /> o � <br /> Applicant Complete All Sections Below This Line z <br /> Applicant's Name: 7D6 torLA-1J ,>j1 <br /> Applicant's Mailing Address: E vey— «M LO N - ` ' +woof miJ SS11411 <br /> ty State Zip < <br /> // tI�/ o � <br /> Applicant's Telephone Number: CD S T7 j2 C 76 OSS3I� S <br /> Applicant's Email: S I U^�� 1(� p✓� _ O 1 <br /> n <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> 1 o <br /> []Letter [:]Phone ,Email P�o noV ►S ALSO Q OOCr <br /> �f °a <br /> Legal Description: <br /> 5;c—'e— <br /> Lot <br /> ;C2Lot#: CSM Vol. Pg. OR <br /> Vl <br /> Lot#: _Block#: Subdivision Name: OR o <br /> Gov't Lot#- 5 OR 1/4 1/4 <br /> Section#: Town#: �N Range#: I 4 W Town of: 5 C D _ <br /> 'Attach additionalpage ifne—elded for lengthy description OR attach a copy of the deed OR attach tax system propertypage.■ <br /> Parcel#(24 digits): 07 — 0 X&- 2- 40 ' HE —`9 4—C,—tii�• ,5—WS—Q r'SOQt� m <br /> ✓ n <br /> o n Z <br /> Tax ID#(1-5 digits): 8 �p� X <br /> Property Site Address: { �j l�O }���( � �p (JUp Vt)✓lf t {/V S�g� I <br /> a <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec• <br /> Ll Single Family Dwelling ❑ Multi-Family Dwelling LJFilling/Grading ❑Commercial Building <br /> ❑Single Family Addition ❑ Muld-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 p`o+rch—campgrounds only Ll Retaining Wall LJSidewalk/Driveway :ff00 <br /> �t6 Mei✓ /Cact l� M <br /> Proposed Structure/Addition Use: o <br /> /y Z(HomrlC m Commercial Business;Bedroom Deck eta) <br /> Building Contractor:!1 t 0 1 0� �t� Master Plumber: L✓�P "s—"j, p! j z <br /> 51— t <br /> Anticipated Start Date: <br /> Page 1 of 4 C rn <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br /> 479" <br />