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LAND USE PERMIT APPLICATION— Burnett Countyd <br /> , WI r <br /> a � � <br /> Permit Fees: <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwellin rinci al Building-Single Family $200 C7 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Stmcture(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse $250 1 <br /> Accessory Structure-Commercial Cl &Il $200 Addition to Accessory Structure-Commercial Cl&Il) $200 \ 1 11 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692 1 v $350 r <br /> Camping Unit $100 Filling/Grading $150 R <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 Boathouse $500 Ln <br /> w <br /> 0 <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. o <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: J'Sv:f: 1,H Q ;J) � T <br /> Applicant's Mailing Address: !1 J �. <br /> � x <br /> City State zip < y <br /> Applicant's Telephone Number: / 3 / > �� 11 ✓1 a,4 c <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. b <br /> Letter Nhone ❑Email <br /> oc <br /> Legal Description: o <br /> Lot#:�_CSM Vol. -7 g. MR OR 1 <br /> Lot#: Block#: Subdivision Name: OR o <br /> F <br /> Gov't Lot#: ' OR 1/4 1/4 <br /> Section#: Town#:_L�_N Range#:_LS;__W Town of: ,SU) (4S Q y i <br /> *A ttach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* /j _ <br /> Parcel#(24 digits): ty <br /> � z 1 <br /> Tax ID#(1-5 digits): <br /> Property Site Address: <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:00 <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs X Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition C <br /> ❑ Boathouse ❑ Screen porch—campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway M <br /> Z D <br /> Proposed Structure/Addition Use: ,,�,r=) k;,.1 �, +_ <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ec _ <br /> n <br /> N <br /> Building Contractor: ST L F z''J 1Master Plumber: )J /,;,� Q o <br /> T' C <br /> Anticipated Start Date: Z Il u D <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />