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LAND USE PERMIT APPLICATION—Burnett County, WI b <br /> Permit Fees: a a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwellin rinci al Building-Multi-Family 5300 Addition to DwcHingtPrincipal Buil <br /> din -Multi-Family $200 A <br /> CommerciaVlndustrial Building $300 Addition to Commercial/hidustrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) f <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(Cl&11) 5200 Addition to Accessory StructureCommercial(CI&11) 5200 <br /> C] <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> Screenporches-in campgrounds only) $125 Gazebo(WI Stat 59.692(l vS350 r, <br /> Camping Unit SI00 Filling/Grading Filling/Grading5150 ° <br /> Permit Extension Valid for one year-Only I Allowed) $100 Boathouse 5500 E' <br /> m <br /> "NOTE:Atter-the-fact(when no 0 permit is obtained prior to construction)is up[o three times the normal fee. R. <br /> "Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> "/tems not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a <br /> 0 <br /> Applicant Complete All Sections Below This Line o <br /> k �l <br /> Applicant's Name: <br /> Applicant's Mailing Address:� kz ` - <br /> v <br /> City State zip <br /> Applicant's Telephone Number: <br /> \ 0 <br /> Applicant's Email:_ 5 <br /> T at <br /> -o <br /> If staff has a question about this application now do you prefer to be contacted? Check one below. � t <br /> ❑Letter (PhoneEmail <br /> Legal Description: .)acs ctcr@S -/`.t 4Z- L4Lk-. <br /> 5. <br /> Lot#: CSM Vol. Pg. OR rn <br /> Lot#: Block#: Subdivision Name: OR 1 °E <br /> Gov't Lot#: OR 1/4 1/4 Q <br /> Section#: Town#: N Range#: W Town of: <br /> "Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system property page.• W <br /> Parcel#(24 digits): 0 <br /> Tax ID#(1-5 digits): <br /> Property Site Address: Y <br /> < I 7y <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:1ey <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑Stairs WAcc.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 <br /> .,-�campgrounds only ❑ Retaining Wall ❑Sidewalk/Driveway <br /> �>hlrs�c Z <br /> Proposed Structure/Addition Use: <br /> ome/Cabinr Commercial Business;Bedroom;Deck:etc.) r <br /> Building Contractor: t/ Master Plumber: <br /> Anticipated Start Date:A5,A0 'f�(���0 <br /> Pagel of 4 U u Y <br /> Burnett County,WI Land Use Application–Rev 3/2016 ��� <br />