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LAND USE PERMIT APPLICATION -Burnett County, WI cl <br /> Permit Fees: <br /> Dwelling/Principal Budding-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 d <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Budding-Multi-Family $200 <br /> CotnmerciaVindustrial Building $300 Addition to CommercialAndustrial Building $200 <br /> Accessory Stmcture(Non-Bunkhouse) G <br /> Addition to Acc.Structure $150 Bunkhouse 5250 q <br /> Accessory Structure-Commercial CI&I1 $200 Addition to Accessory Structure-Commercial C1&11 $200 n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& o <br /> Screenporches-in campgrounds only) $125 1 Gazebo Wl Stat 59.692 Iv $350 <br /> Camping Unit $100 Filling/Grading Filling/Grading $150 °» <br /> Permit Extension Valid for one year-Only 1 Allowed $100 Boathouse $500 Cn <br /> "NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal tee. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. 9 <br /> *Items not listed above will be treated as acce*xvy structures,such as:pergolas, landscaping,etc. <br /> o <br /> Applicant Complete All Sections Below This Line p <br /> Applicant's Name: j6m.��= <br /> Applicant's Mailing Address: ui l{t b <br /> City State Zip <br /> O b <br /> vy <br /> Applicant's Telephone Number: 1,r--7&k—0037 c <br /> ��+ d <br /> Applicant's Email: Y2,•1C�C..�l� � �ue.L�vo. C.>' <br /> r` <br /> b <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter (]}P�ione Email � <br /> �'JJ u° � <br /> Legal Description: d W <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR G <br /> Gov't Lot#: OR—1/4 1/4 1�-4^ <br /> Section#: Town#: N Range#: W Town of: <br /> I <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): <br /> `L 4) z <br /> Tax ro#(1-5 digits): / � M � <br /> Property Site Address: W() COtA-ZA`�y X 14- e <br /> a <br /> TYPF�OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building r <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition C/-I PI e, rime- <br /> ❑ Stairs ❑ Acc. 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 0 Sidewalk/Driveway 11 U3 <br /> Proposed Structure/Addition Use: �b/y\ C�ongt 4 -Vf0r N 5f," �@ f m�7� C 4•---�` -J <br /> . '/e u\ (Home/Cabin:Commercial Business:Bedroom:Dec O MBuilding Contractor: Com—� (,t-Ok S M e Master Plumber: Z f�1 <br /> Anticipated Start Date: 1 '�,_t a S � U/(n A ( tl*.f O O <br /> J Page 1 of 4 Z C' <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />