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LAND USE PERMIT APPLICATION— Burnett County, WI a _ b <br /> . w <br /> n ~ <br /> Permit Fees: °= a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 L <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 0 <br /> Accessory Structure(Non-Bunkhouse) E <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &It) $200 Addition to Accessory Structure-Commercial Cl &11) $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& °< <br /> Screen orches-in campgrounds only) $125 Gazebo Wl Star 59.692(lv)) $350 - (r. <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Permit Extension Valid for one year-Only t Allowed $100 Boathouse $500 <br /> d <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. b <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> �YApplicantComplete All Sections Below This Line 1 0 <br /> Applicant's Name: \ u L- tC` , A VY, S AJG c Cv�VwK S <br /> Applicant's Mailing Address: 1-0.1 VA k( J n OIM OV1 e wt 5V 751 <br /> City State zip < <br /> tt0 <br /> O_ <br /> p I y <br /> Applicant's Telephone Number: I I `J " -z - 1 `l a <br /> b <br /> Applicant's Email: I( (-- IzA G.h Yh S Q VNUA- u t ( • L i/h <br /> If staff_has a question about this application how do you prefer to be contacted? Check one below. N <br /> ❑Letter ®Phone ❑Email <br /> 5 rY' <br /> °C 1 <br /> Legal Description: G <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR o C <br /> Gov't Lot#: r= OR 1/4 1/4 >, <br /> Section#: _Town#:_k()__N Range#:_L� W Town of: SCCs 1- H I <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): Q a�8~ off'J4 0 - 1 L{-a�-rJ 'UU�J Q (p�Q CO <br /> z <br /> Tax ID#(1-5 digits): 1 p In1d [ <br /> Property Site Address: Ila gp�ffTS �DtX:)YIeY LJZ ST�� <br /> c �1�-� <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:�t,li <br /> ,Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial 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 co -n, <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway Cal <br /> Proposed Structure/Addition Use: U I IT <br /> h'(, <br /> (Nome/Cabin;Commercial Business;Bedroom;Deck;etc.) —'{ � I� <br /> Building Contractor:0 ? <I1 r U CJ� 8h 10 Master Pumber�NYS� 6 ZO0 � C=o( <br /> Anticipated Start Date: '7�l S�aU/G, <br /> Z rn T: <br /> Page 4 <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />