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LAND USE PERMIT APPLICATION— Burnett County, WI a b <br /> Permit Fees: <br /> a <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin a Family $200 G <br /> t.— <br /> DwelLinglPrincipal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> CommerciaUlndustrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) l <br /> Addition to Ace.Structure $150 Bunkhouse $250 ; <br /> Accessory Structure-Commercial C1 &Il $200 Addition to Accessory Structure-Commercial C1 &II) $200 <br /> Deck/Stairs/Patio/Retaining WalUSidewalk/Driveway& <br /> (Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692 Iv $350 S <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 Boathouse $500 IJN <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. ti <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping, etc. <br /> ((Applicant Complete All Sections Below This Line o <br /> Applicant's Name: -)0"A Q> <br /> Applicant's Mailing Address: i U ��1 ( fir� WrT 500 7 o <br /> City State Zip <br /> Applicant's Telephone Number: `71,5 607 bd 56 a r <br /> Applicant's Email l4 L4d&V&/!(CftQQT0v#CoV 4 <br /> 1 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N °O <br /> ❑Letter/ ❑Phoner�mail <br /> OQ <br /> Legal Description: j�� tD t �� l � N� d <br /> ti <br /> tj <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR o i <br /> Gov't Lot#: OR A 1/4 1/4 i 1 <br /> Section#: �Town#:qoM N Range#: �W Town of: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits): 0-7— Qk" L{Q --1((j -dA <br /> Z <br /> Tax ID#(1-5 digits): <br /> Property Site Address: S <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: w <br /> 13Single Family Dwelling L3 Multi-Family Dwelling LlFilling/Grading L3Commercial 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 C �� <br /> Proposed Structure/Addition Use: C14 cL4qO� <br /> n 1Tjj <br /> ZI <br /> (Home/Cabin;Commercial��iness;Bedroom;Deck etc.) M <br /> A 11� N t/1\t <br /> Building Contractor: w Master <br /> Plumber. Z O Q' <br /> Anticipated Start Dater o`� —� C <br /> Page 1 of 4 Z <br /> Burnett County,WI Land Use Application—Rev 3/2016 :� �� <br />