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LAND USE PERMIT APPLICATION - Burnett County, WI b <br /> Permit Fees: <br /> a <br /> Dwellin rinci al 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 /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 /vim <br /> Accessory Structure(Non-Bunkhouse) v <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &Il) $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(l v $350 r <br /> Camping Unit $100 Filling/Grading $150 ° <br /> s <br /> Permit Extension Valid for one year-Only I 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 different application form,see corresponding application and fees. ro <br /> 4-1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. <br /> or — <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: �j re ti <br /> A <br /> Applicant's Mailing Address: ;230q0 C)Q 3.5 �>?�vl /,(h 5 01 � b <br /> City State zip # <br /> o y <br /> c <br /> Applicant's Telephone Number: <br /> d <br /> Applicant's Email:A fe-t, t„ ,y/`( 0) A uo4r C, de A4 <br /> I <br /> �u <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter E3fhone M mail a <br /> ov I <br /> Legal Description: o <br /> Lot#: / CSM Vol. qtl& Pg. a j a OR I <br /> Lot#: Block#: Subdivision Name: OR o <br /> f <br /> Gov't Lot#: OR 1/4 1/4 ° <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional page if needed for lengthy description OR attach a cop of the deed OR attach tax system property page. <br /> Parcel#(24 digits): SY //--w, q,,, 4 <br /> L e >��T�17ell <br /> z Q <br /> Tax ID#(1-5 digits): e S "t° e /� j <br /> Property Site Address: sir° /r /4-L�� PGE' 3()yU o <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: e <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs ;K'Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition <br /> Ll Boathouse L3 Screen <br /> /porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway C f�.J �LJ <br /> Proposed Structure/Addition Use: (7 AAA A(,7E m n <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: nn Master Plumber: <br /> 4 c— <br /> Anticipated Start Date: S� P C rn <br /> Page 1 of 4 1 <br /> Burnett County, WI Land Use Application—Rev 3/2016 <br />