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LAND USE PERMIT APPLICATION- Burnett Countv, NINA70 <br /> a <br /> y' <br /> N �\ <br /> Permit Fees: c <br /> a <br /> Dwelling/Principal Building-Sin le Family $300 Addition to DwellingfPrincipal Building-Sin le Family $200 <br /> DwellingfPrincipal Building-Multi-Family $300 Addition to Dwellin rind al Building-Multi-Fan-y $200 a <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse $250 1 <br /> Accessory Structure-Commercial C l &1 I) $200 Addition to Accessory Structure-Commercial C l &11) $200 G] <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& o <br /> (Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692 lvp $350 r <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only I 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. a <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. <br /> Applicant Complete All Sections Be ow This Line _— o <br /> Applicant's Name: h 0 M A <br /> Applicant's Mailing Address: D(/n <br /> Ci State Zi z <br /> Applicant's Telephone Number: �SI _ 'T /r — �c0 I a , <br /> d <br /> w <br /> Applicant's Email: <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> [-]Letter Phone ❑Email f <br /> Legal Description: r �1Zj7 y O Alk 17 0 <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: Ut VA9'eO7 l <br /> F <br /> Gov't Lot#: OR X1/4 1/4 ,/� , / / l <br /> Section#: 2© Town#: T N Range#:Z& W Town of (947AX?lyd <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> Parcel#(24 digits): O7-071 Z—�O�� —7�_S <br /> Z <br /> Tax ID#(1-5 digits): <br /> Property Site Address: -W911/9 a nell r5-+-. 5c <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> RM <br /> ❑ ingle Family Dwelling ❑ Mul '-Family Dwelling ❑ Filling/Grading ❑ Commercial Buildingd� 50 00 <br /> Single Family AddiWG <br /> Addition ❑ Deck/Patio ❑ Commercial Addition 5o IQ <br /> ❑ Stairse(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension Stat59.692(1v) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> ❑ Boathouse —campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway <br /> Cn <br /> T� ✓ e CSC ! 5�sari Pc�h _ \ N m <br /> Proposed Structure/Addition Use: �/Y/.p , O <br /> (` (Home/Ca n;Commercial Bus mess;Bedroom;Deck;etc) Z <br /> Building Contractor: �r��T Master Plumber: Z 0 lh�i u <br /> — G)O cm <br /> Anticipated Start Date: Z c—" <br /> I. Page 1 0 4 r�—I <br /> �7 x� <br /> PIP" <br /> a�"v�'I Burnett County,WI Land Use Application–Rev 3/2016 <br />