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CA <br /> LAND USE PERMIT APPLICATION — Burnett County, WI Cr <br /> a <br /> Permit Fees: o� <br /> a <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Family $200 � O <br /> Dwellin, rinci al Building-Multi-Famil $300 Addition to Dwellin rinci al Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaUIndustrial Building $200 r y O <br /> Accessory Structure(Non-Bunkhouse) E <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> AccessoryStructure-Commercial Cl &Il) $200 Addition to AccessoryStructure-Commercial Cl&11 $200 Q <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> Screen orches-in campgrounds only) $125 Gazebo Wl Stat 59.692 lv $350 S <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only1 Allowed $100 Boathouse $500 d <br /> a <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. w' <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. ro <br /> *Items not listed above will be treated as accessorystructures,such as:pergolas, landscaping,etc. <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: �O VVt 0.S T /I <br /> Applicant's Mailing Address: gg4c) ro x ��2� 1(GtCt° . tnblAfu � S'78,3a b <br /> City I State Zip < <br /> y J <br /> Applicant's Telephone Number: 715 '25-67- 96Z 7 a <br /> v <br /> Applicant's Email: <br /> v <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. 00 <br /> ❑Letter ❑Phone ❑Email V 'S <br /> Legal Description: Part-et SW NE: Fac X37/0 74 1� PC-` 5 Ya A f E U. <br /> Lot#: CSM Vol. Pg. OR 5. <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: 02 8 Town#: 4/ N Range#:�W Town of: SCJ i S S <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> 01-©31- a -`If-f(o -ol$-1 03-000 - 011000 Ul` <br /> Parcel#(24 digits): D'7 -o 3 a -a- Z/I-/(c -a,, <br /> n z <br /> Tax ID#(1-5 digits): cZ a O(O 9 -4- 0�a 0'7 2 y <br /> Property Site Address: 30 a9 5- /J, G iQ 5S S+, <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:lsoGwsv", <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs A 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 W 0 <br /> Proposed Structure/Addition Use: l7C�r0. _ <br /> Nj C <br /> (Home/C in;Commercial Business;Bedroom;Deck;etc.) Q M <br /> Building Contractor: Hoy"f- O tvru✓ -Tow ~ <br /> �y��Master Plumber: /V�� Z A <br /> 20 <br /> Anticipated Start Date: N1 ,jl- Sv ti7 0 � <br /> Page 1 of 4 Z "' [ice <br /> Burnett County,WI Land Use Application-Rev 3/2016 4. [r <br />