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LAND USE PERMIT APPLICATION - Burnett County, WI � <br /> y 1 <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to DwelliggTrincipal Building-Single F $200 C7 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commemial/Industrial Building $300 Addition to Commercial/industrial Building $200 O <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Ace.Stricture $150 Bunkhouse $250 t 2 <br /> Accessory Structure-Commercial Cl&11) $200 1 Addition to Accessory Structure-Commercial Cl &11 $200 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& � ` <br /> Screen rches-in campgrounds only) $125 Gazebo Stat 59.692 Iv $350 4 <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Pemtit Extension(Valid for one year-Only 1 Allowed $100 Boathouse $500 m <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. <br /> a <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> 0 <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: MAIrk 7 ber t, <br /> Applicant's Mailing Address: E)5aci5 w4yVlc-ln la l7�'�yt�' yy I.JL Szir�yG ro <br /> City State Zip <br /> 0 <br /> � f/� c <br /> Applicant's Telephone Number:(p)a-ort/6 - loll I8 } r <br /> Applicant's Email: YYlDI " C& ) nLt <br /> � v , <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. t <br /> 0 <br /> Letter [t]Kone ❑Email t <br /> Legal Description: c r4; v x � c � d <br /> a <br /> Lot#: CSM Vol. Pg. OR " '��5MJAn + <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 p <br /> Section#: @5 Town#: _N Range#' l�_W Town of:U57L�ars�11G Vl%J� � <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits): 0'7 No a -39 -1$ ^96 - 3 ©1 -600 -pl 1000 c5 <br /> n z <br /> Tax ID#(1-5 digits): Ol7SJ 7 w ` <br /> Property Site Address:050?95 VJFd mrn pa Cmwrl�S�t tNa S49410 <br /> TYPE OF PERMIT(S); Check appropriate box/boxes Fee Rec° rQ� <br /> L) Single Family Dwelling Ll Multi-Family Dwelling LlFilling/Grading LJ Commercial Building <br /> 23ingle Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commerdal Addition <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-W1 Stat 59.692(iv) ❑Camping Unit ❑ Commercial Acc.Addition <br /> ❑ Boathouse ❑ Screen porch-campgrounds only is Retaining Wall ❑ Sidewalk/Driveway C ----�-� <br /> Proposed Structure/Addition Use:�}� Gde1 i-l;en , YY 64—^- 6&1+� , � b&4-) + 14vi n_ i 77) <br /> z <br /> (Home/Cahin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor /�anney:ale, Master Plumber: O N <br /> ca <br /> Anticipated Start Date: G ^o�'/� � m <br /> Page 1 of .� <br /> Burnett County,WI Land Use Application—Rev 3/2016 �� <br />