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LAND USE PERMIT APPLICATION — Burnett County, WI g <br /> O <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 a O <br /> DwellingfPrincipal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 m <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Stmcture(Non-Bunkhouse) <br /> Addition to Ace.Structure $150 Bunkhouse $250 I <br /> a <br /> Accesso Structure-Commercial C 1 &11 $200 Addition to Accesso Structure-Commercial C 1 &I l) $200 0 } <br /> Deck Stairs Patio/Retaining Wall/Sidewalk/Driveway& ° <br /> (Screen orches-in campgrounds only) $125 azebo(WI Stat 59.692(lv)) $350 r <br /> Cam m mt $100 Fillip Gradin $150 ° <br /> Permit Extension CValid for one year-Only 1 Allowed $100 Boathouse $500 Ln <br /> m <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. z <br /> v <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. rn <br /> —�^ r Applicant Complete All Sections Below This Line o <br /> Applicant's Name: <br /> Applicant's Mailing Address: & J70 RIce C i-ee <br /> City Mate Zip < <br /> Applicant's Telephone Number: 6 2 - 8 1 3 3 1 a <br /> Applicant's Email: Q of ; e r'a n _ g e o wl e a s�. h(3 a <br /> ro t <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> 0 <br /> Letter ®Phone ZEmail <br /> Legal Description: o <br /> 5. <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR ( $� <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 copy of the dee OR attach tax system property page.* <br /> r <br /> Parcel#(24 digits): D 7- Oz O Z 'y 0 -��o ' z3 ' S DS- O O G - O/ y UOQ Z <br /> n z <br /> Tax ID#(1-5 digits): <br /> / <br /> Property Site Address: Z 8 10 S' S ./• p !4 h S Oh 1�ak c " <br /> a <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: _.��i <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> AStairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(iv) ❑ Camping Unit ❑ Commercial Acc. Addition <br /> L3Boathouse L3Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway C <br /> C <br /> replgce 1 M D <br /> Proposed Structure/Addition Use: (- R h;h S 7 dsi S l4 t m <br /> t ome/Cabin;Commercial Business;Bedroom;Deck.etc.) 0 <br /> N O <br /> ZA <br /> Building Contractor: S e-I-rr Master Plumber: <br /> Anticipated Start Date: $�to Q S S o all al S q ��i e /� �' C <br /> Page 1 of 4 Z <br /> Burnett County, W1 Land Use Application—Rev 3/2016 <br />