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LAND USE PERMIT APPLICATION —Burnett County WI a <br /> Permit Fees: <br /> a ' <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwellin /Princi al Building-Sin le Family $200 e <br /> d <br /> Dwelling/Principal Building-Multi-Famil $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) 0 <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(CI &11) $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(WI Stat 59.692(]v)) $350 <br /> Camping Unit $100 Fillin /Gradingo <br /> $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. <br /> *Communication Towers&Signs require a di(ryerent application form,see corresponding application and fees. <br /> e <br /> *Items not listed above will be treated as accessory structures,such as:pergolas.landscaping, etc. <br /> 0 <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name:_ 0,, l///, LJAL TLS/t PST-Stift <br /> Applicant's Mailing Address: `aJ U X *60'A- A-*lX 2?ld%wG iYltJ Js'43 <br /> 'z <br /> City State Zip <br /> Applicant's Telephone Number: 76 <br /> Applicant's Email: coA 11 y <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> 0 <br /> ❑Letter [done Qi mail <br /> 5' <br /> w <br /> Legal Description: ZabT loo <br /> h <br /> Lot#: la CSM Vol. d/PPg. J34- OR q" <br /> Lot#: Block#: Subdivision Name: OR ` I <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional page if needed for lengthv description OR attach a copy of the deed OR attach tax system proper&page.* (b <br /> Parcel#(24 digits): F S <br /> rr z O <br /> Tax ID#(1-5 digits): <br /> Property Site Address: <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:_�50 <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs 6trAcc. 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/Drivewayy ��J ( J�J� <br /> Proposed Structure/Addition Use: '-d� s i2/4 G e Sly G S 'OiIC' ' i�r^ C M <br /> (Horne/Cabin;Commercial Business;Bedroom;Deck; <br /> etc.) N Z r <br /> Building Contractor:%ict /e lrp�T. ��� S• Master Plumber: Z N <br /> /Y J'/9 /� 9 2 to <br /> Anticipated Start Date: rat <br /> Pagel of 4 Q' <br /> Burnett County,WI Land Use Application-Rev 3/2016 <br />