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LAND USE PERMIT APPLICATION —Burnett County, WI a b <br /> N y Nr <br /> Permit Fees: IT1 <br /> o. <br /> Dwellin i?rinci al Building-Single Family $300 Addition to Dwellin /Princi al Building-Single Family $200 r C <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 Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 khouse $250 <br /> Accessory Structure-Commercial(C1&11) $200 Addition to Accessory Structure-Commercial(C I &I1) $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> (Screen orches-in campgrounds only) $125 Gazebo(Wl Stat 59.692(lv)) $350 r <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 Boathouse $500 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. d' <br /> *Communication Towers&Signs require a d(yjerent 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 /> r <br /> Applicant Complete All Sections Below This Line e o <br /> Applicant's Name: R EJ) ( a YW o R7T (-/ p� <br /> Applicant's Mailing Address: C31 `a U ltd to r Lu f� S 4f o!3 <br /> � t s a- ¢b� � <br /> City State Zip < <br /> ° r d <br /> O � <br /> Applicant's Telephone Number: �la 1 a,4'� c <br /> Applicant's Email: L_7 A)IV?, FR C YJ <br /> 1 <br /> b <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N I <br /> 0 <br /> ❑Letter ®Phone ❑Email <br /> w � <br /> Legal Descripti n: o <br /> Lot#: CSM Vol._ Pg. /_7Z OR <br /> Lot#: Block#: Subdivision Name: OR o <br /> Gov't Lot#: OR 1/4 1/4 9 ) <br /> Section#:_Z& Town#:_2_� -N Range#:-Z6—W Town of: �pylO!/f <br /> I <br /> *Attach additional page irneeded far lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> ( g ) ©7_e10 -2-,5_F ��- -� O/-Q©© <br /> Parcel# 24 di tts <br /> r) z <br /> Tax ID#(1-5 digits): <br /> 32Z Q ✓�' Q) <br /> Property Site Address: tel' S ,� <br /> 0 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: /s0 <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs cc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway C <br /> C <br /> Proposed Structure/Addition Use: a4� u-ot,Ct'e N �fl <br /> (HomelCabm;Comme)tial Business;Bedroom;Deck;etc.) O <br /> Building Contractor: Master Plumber: Z Cry <br /> Anticipated Start Date: QLt, .t ( b r m Cl o_ <br /> Page 1 of 4 Z Q <br /> Burnett County, WI Land Use Application-Rev 3/2016 <br />