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LAND USE PERMIT APPLICATION —Burnett County, WI a b <br /> Permit Fees: a °' <br /> Dwell in rinci al Building-Single Family $300 Addition to DwellingfPrincipal Building-Single Family $200 <br /> Dwell in rinci al Building-Multi-Family $300 Addition to Dwellin rinci al But ding-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Strucmre(Non-Bunkhouse) <br /> Addition to Ace.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &11) 1 $200 Addition to Accessory Structure-Commercial Cl&I1 $200 <br /> n 1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> (Screen orches-in campgrounds onl ) $125 Gazebo(WI Stat 59.692(lv)) $350 r <br /> Camping Unit $100 Filling/Grading $150 °^ <br /> Permit Extension Valid for one year-Onl 1 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. D <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> r^ <br /> Applicant Complete All Sections Below This Line o <br /> 0 a 1 ) <br /> Applicant's Name: f : S-g42, /- <br /> Applicant's Mailing Address Q f 1 e 13(-.r v?r 5a• 14 MA)sS 9 <br /> City State Zip Z <br /> E ' <br /> Applicant's Telephone Number: a - a - lU <br /> Applicant's Email:r-?c, r k L�-,r`++5 � c?✓1 C(�Cr--I._C <br /> n <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N t <br /> 0 <br /> i ❑Lettter Phone + ❑Email <br /> Legal Description/( 1<.-,,4 -S hvr�s Lz41 z,'l,__ L Z. _�2 ti PVT <br /> a <br /> Lot#: lX CSM Vol. Pg. OR <br /> Lot Block#: ] Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#.1_�_(Q Town#: } N Range#: 11+ W Town of: 0CJ(kc A <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* v} <br /> Parcel#(24 digits):6 7 "y),(DI a - go "- I(> - [(R <br /> r, z t� <br /> Tax ID#(1-5 digits): j� $ �rD X <br /> Property Site Address: 71 3 y l rs b;. 14 (J�3c) `1 <br /> c <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: co <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Mufti-Family Addition XkAeck/Patio ❑ Commercial Addition <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc.Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(Sv) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway <br /> / <br /> Proposed Structure/Addition Use: t' �y.Z t Z e, u 5 tic de-e-L S d iN4 i t'ie Q 4m i <br /> N eei <br /> (Home/Cabin;Commercial Business; edroom;Deck:etc) N <br /> Building Contractor: Master Plumber: all r--= <br /> cza o <br /> Anticipated Start Date: P �'• <br /> Page 1 of 4 <br /> Burnett County, WI Land Use Application—Rev 3/2016 <br />