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LAND USE PERMIT APPLICATION—Burnett County, WI _ <br /> N <br /> w fr <br /> Permit Fees: o a <br /> Dwellin Princi al Building-Single Family 40t, Addition to Dwellin ci al Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 ^]} <br /> Commercial/Industrial Building $300 Addition to Commercial Industrial Building $200 / O <br /> Accessory Structure(Non-Bunkhouse) v , <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl&11) $200 Addition to Accessory Structure-Commercial Cl&11 $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> Screenporches-in campgrounds only) $125 Gazebo WI Stat 59.692 lv) $350 <br /> Camping Unit $100 Filling/Grading $150 <br /> R <br /> Permit Extension Valid for one year-Only 1 Allowed $100 Boathouse $500 w <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Applicant Complete All Sections Below This Line Z <br /> Applicant's Name varre-I _ - cc—Y) II __ \ <br /> Applicant's Mailing Addre 30o ��I I f'f1l e, l i7(,LIS ) m _�A ro <br /> City - State Zip y <br /> e <br /> Applicant's Telephone Numb1er: # � ti dPrLS <br /> Applicant's Email: 6 1 0a <br /> ro <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> OLetter ElPhone MEmail <br /> Legal Description: tea+vsea s �ka caw a.. lJi v o� L Jd,i 1 1.:14 r Lcr1-Z. i ? Y' I o <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Z Block#: I Subdivision Name: a L�Kc S(�� o +.j w OR o <br /> l -cmL LACE � 1 <br /> Gov't Lot#: OR 1/4 1/4 \ <br /> Section#: Town#: 3$ N Range#: W Town of: 006%-> <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> r <br /> Parcel#(24 digits): 15 - 3S4- O 1 ?_Qou <br /> � z 1 <br /> Tax ID#(1-5 digits): Z9 S 13 y <br /> Property Site Address: I l S9'l Ne S� « e� �• 'uo. _�s17 ��}z S�l�yt� <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec tD <br /> Z Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial 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—campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway t Q <br /> Proposed Structure/Addition Use: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc) <br /> Building Contractor: ` Master Plumber. (moor- Tc.)G d,4._ //�y��'1 W ^U <br /> \J N <br /> C===U <br /> Anticipated Start Date: fa y Zd/(� C _ociig <br /> Page 1 of 4 Z <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />