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C ry l <br /> LAND USE PERMIT APPLICATION —Burnett County, WI a � <br /> Permit Fees: o <br /> a <br /> a <br /> Dwellin /Princi al Building-Single Family $300 Addition to Dwelling/Princi xl Building-Sin le Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> CommercialAndustrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Stmcture(Non-Bunkhouse) O <br /> Addition to Acc.Structure $150 Runkhouse $230 I <br /> Accessory Structure-Commercial(C I&11) $200 Addition to Accessory Structure-Commercial (Cl &11) $200 <br /> DccklStairsll'atio/Retaining Wall/Sidewalk/Driveway& <br /> (Screen orches-in campgrounds only) $125 Gazebo(WI Stat 59.692(l v)) $350 <br /> Camping Unit $100 Filling/Grading'Gradin <br /> $150 <br /> Permit Extension(Valid for one car-Only 1 Allowed) S100 Boathouse S500 a <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. 2 <br /> *Communication Towers&Signs require a dii ferenl application form,see corresponding application and fees. <br /> z (� <br /> *items not listed ahove will be treated as accessory structures, such as:pergolas, landscaping, etc. <br /> r � <br /> o - <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: 1M b i1Ul KPA 61 , 1 <br /> Applicant's Mailing Address:_12 <br /> City State Zip <br /> Applicant's Telephone Number: <br /> Applicant's Email: M <br /> ��_J�lC�ofJ �C}�1 �i,JLc( IZEr <br /> s1,r n� <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N d <br /> ❑Letter KPhone ❑Email 'S <br /> ffa <br /> Legal Description: c. <br /> Lot#: _ CSM Vol. Pg. OR - J CQ <br /> Lot#: Block#:_ Subdivision Name: OR o <br /> Gov't Lot#: OR 114 1/401 <br /> ( _ <br /> Section#: Town 4: N Range#: W Town of: /vt"� <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach lax system property page. <br /> r, <br /> Parcel#(24 digits): <br /> (��j �l <br /> Tax ID#(1-5 digits): I Ul J� iA�` <br /> Property Site Address:�_ZQ� W cn—A - V V 1 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: ��� <br /> J Single Family Dwelling LJ Multi-Family Dwelling J Filling/Grading J Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition J Deck/Patio J Commercial Addition <br /> ❑ Stairs A Acc. Structure(Non-bunkhouse) J Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) J Camping Unit ❑ Commercial Acc.Addition C--_—� <br /> ❑ Boathouse ❑ Screen porch-campgrounds only J Retaining Wall ❑ Sidewalk/Driveway <br /> Proposed Structure/Addition Use: R-1�(jr� - - a <br /> (HonreiC'abin;Conrnrercial Business;Bedroom,-Deck, etc.) C <br /> ���� <br /> (( N Z Z <br /> Building Contractor:-POZPC A' Q� LJ -1&:S Master Plumber: A)LA z <br /> Anticipated Start Date: Olv2Tm� <br /> 2 C N <br /> Page 1 of 4 <br /> Burnett County, Wl Land Use Application —Rev 3/2016 <br />