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LAND USE PERMIT APPLICATION— Burnett County, WI a 3 c <br /> Permit Fees: s Q` <br /> Dwelling/Principal Building-Single Family $300 Addition to DwellingtPrincipal Building-Single Family $200 C7 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family00 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) f <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(Cl &11 $200 Addition to Accessory Structure-Commercial(Cl&11 $200 <br /> L1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> Screenporches-in campgrounds only) $125 Gazebo Wl Stat 59.692(l v)) $350 <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Onl 1 A]lo%. ed) $100 Boathouse $500 <br /> m <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 /> r <br /> o - <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: �ic,�< tt1Gl Sa,ti, •yy ,t�TLvi�'f <br /> Applicant's Mailing Address: 3 G'f`I FRt9N1'y' /4✓i- A) �c � = <br /> City State zip <br /> o <br /> Applicant's Telephone Number: Cell (rI� zGq-510t� I 1 �Cr+tt' 1(p3_J�Z-05?fj <br /> /I 0 <br /> Applicant's Email: �rcv �_ �eyr� Q Cow( 4st w+ <br /> 1 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter Phone ❑Email <br /> � t <br /> Legal Description: RLr <br /> I <br /> Lot#: Z CSM Vol.�Pg. r 3 J OR <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 F <br /> (Yr 1 v l <br /> Section#: Q Town#: �N Range#: /�W Town of: S�t�y 5 H <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system property page. <br /> Parcel#(24 digits): Ops-,0 0Z- O LO O D O <br /> n z <br /> Tax ID#(1-5 digits): 2. 1 ZfR // a <br /> Property Site Address: -31 :3 DO S 7� �P� �ql��_ �,vt lij y,"^ <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Recd[�o <br /> ❑- ingle Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> J�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 � �1 <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway C <br /> 1 , I II u t+ <br /> Proposed Structure/Addition Use: h q 1 s U' I �^N y IO! T�1 11� 4 u r�q�q�,bn11 t'gG1 N Z m� <br /> (Home/Cabin:Comm rcia!Business:Bedroom:Deck:etc /� Z O n u <br /> Building Contractor: Master Plumber: -20 <br /> Anticipated Start Date: l r1 nc 011 C cn <br /> J Page 10 4 Z <br /> Burnett County, WI Land Use Application—Rev 3/2016 :� C� <br />