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LAND USE PERMIT APPLICATION - Burnett County, WI a b <br /> N <br /> Permit Fees: ry IF, <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 ry <br /> Commercial/industrial Building $300 Addition to Commercial,/Industrial Building $200 O <br /> Accessory Stmeture(Non-Bunkhouse) 1 F <br /> Addition to Ace.Structure $150 Bunkhouse $250 ', <br /> Accessory Structure-Commercial(C1&Il) $200 Addition to Accessory Structure-Commercial(Cl &Il) $200 <br /> G] Tj <br /> Deck/Stairs/Patio,/Retaining WaIVSidewalk/Driveway& ° <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat59.6921v ) $350 r, <br /> Camping Unit $100 Filling/Gradin $150 <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 Boathouse $500 d <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 /> 0 <br /> Applicant Complete All Sections Below This Line L� o <br /> Applicant's Name:�Jt�(Iat C ` JS V j� <br /> Applicant's Mailing Address: a� Win <br /> r 7 CityState Zip <br /> Applicant's Telephone Number: "J � o� P� <br /> 0 <br /> Applicant's Email: � (ainidy"r A i-(n OIA l-1 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N °0 <br /> � 1 <br /> []Letter Phone %Email 2. <br /> g P � I/� e'�� `(L4 C A-tay. SO <br /> Legal Descri tion: � �- <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#:--6 OR 1/4 1/4 <br /> Section#:_ Town#:-"_N Range#:_5__W Town of: 3(KC <br /> *Attach additional page if neededfor lengthy description OR attach as copy of the deed OR attach taxi system property page- <br /> Parcel 9(24 digits): <br /> age.Parcel#(24digits): b✓]-��a- � - >�� -�5-711-� -`L��O-C /�t�Vl l w <br /> n � z <br /> Tax ID#(1-5 digits): 2 `-tq 0`3 (M(� <br /> Property Site Address: 1 <br /> � 1 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building by <br /> LI Single Family Addition LJ Multi-Family Addition ❑ Deck/Patio :1 Commercial Addition 1� <br /> �) Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(iv) ❑ Camping Unit ❑ Commercial Acc. Addition C <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway Z cn Eva <br /> m <br /> Proposed Structure/Addition Use: T'(nj ISS }tn9M ('j�w 7� s� <br /> Co <br /> (Home/Cabin;Commercial Bu iness:Bedroom;Deck:etc.) 1 _� O �p <br /> Building Contractor:�I-/y 1` 4l P-( kI`e t'3 Master Plumber: l 4� o <br /> aC2(1 Z rn <br /> Cn <br /> Anticipated Start Date: n <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />