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LAND USE PERMIT APPLICATION — Burnett County WI C r <br /> a <br /> Permit Fees: <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 <br /> Cotntnercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 O <br /> Accessory Structuroon-Bunkhouse) <br /> Addition to Ace.Structure $150 Bunkhouse <br /> $250 ;o <br /> Accessory Structure-Commercial Cl&11) $200 Addition to Accessory Structure-Commercial Cl &Il) $200 <br /> Deck/Stairs/Patio/Retaining WalUSidewalk/Driveway& o <br /> (Screen orches-in campgrounds only) $125 Gazebo(Wl Stat 59.692(ly) $350 <br /> Camping Unit ALOL Filling/Grading <br /> $150 <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 Boathouse $500 m <br /> After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. 2. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. W <br /> 0 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping, etc. r � <br /> o — <br /> Applicant Complete All Sections Below This Line r 5 1 0 <br /> Applicant's ham,_: Tco ----_----- <br /> Applicant's Mailing Address: (n5`d KPn-ne ,t OD{, + Fa j L�( ,eek F 1 5474 a <br /> City State Zip C <br /> -1O y <br /> Applicant's Telephone Number:/15- U q I -18q a a <br /> Applicant's Email: ru� u1 e-rj 0��iq�jQQ . cpm <br /> i <br /> 1 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. iN o0 <br /> ❑Letter MPhone ®Email 5 <br /> Legal Description: _ d <br /> Lot 3 _ CSM Vol. pg. <br /> 33(a OR h <br /> Lot#:__. -__ Block#:_ __ Subdivision Name:_ OR <br /> Gov't Lot#: OR 1/4—1/4 l J <br /> Section#:2 Town#:_-SDN Range#: _W Town of:— �pyl y <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach lax system property page. <br /> r <br /> 1 <br /> Parcel#(24 digits):_ �. <br /> n z <br /> Tax ID#(1-5 digits): rj$q u <br /> Property Site Address: <br /> I <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes <br /> LJ Single Rec:.�.� <br /> Single Family Dwelling Multi-Family Dwelling LJFilling/Grading Ll Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs ❑ Acc. Structure (Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure C� <br /> ❑ Permit Extension ❑ Gazebo–WI Stat 59.692(ly) *Camping Unit ❑ Commercial Acc. Addition � <br /> ❑ Boathouse ❑ Screen porch–campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway <br /> Z zProposed Structure/Addition Use: <br /> (Home/Cabin,Commercial Business;Beclroorn;Deck,-eic.) <br /> Building Contractor:-------------- Master Plumber: 0 N <br /> o <br /> Anticipated Start Date: <br /> — Z o" <br /> Page 1 of 4 <br /> Burnett County, WI Land Use Application—Rev 3/2016 <br />