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LAND USE PERMIT APPLICATION—Burnett County, WI a _ <br /> w' <br /> N <br /> Z 70 <br /> Permit Fees: c <br /> o <br /> Dwellin Princi al Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwelling/Principal Building-Multi-Famil $200 <br /> CommerciaVlndustrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse $250 ° <br /> Accessory Structure-Commercial(C1 &I1) $200 Addition to Accessory Structure-Commercial Cl &11) $200 <br /> o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& � <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(l v) $350 <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Permit Extension Valid for one year-Ordy 1 Allowed) $100 Boathouse $500 w <br /> *NOTE:Ager-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. � <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: G/� _ I'1 <br /> Applicant's Mailing Address: jeo Q S I-"' L1y S;�b7/ b <br /> City State Zip < <br /> O y <br /> - <br /> Applicant's Telephone Number: (o <br /> d <br /> Applicant's Email: �I n_�`cn @ M/f C. CcAj 1 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N 00 <br /> a <br /> ❑Letter [Phone Email ' <br /> Legal Description: CQ } nup / v .60)CttmQtf0- /S7 <br /> Lot#: CSM Vol. ( Pg. j OR <br /> Lot#: Block#: Subdivision Name: OR f <br /> Gov't Lot#:9'OR 1/4 1/4 Gee'-4or-& ] 5oe+lon k► 3<o <br /> y � l <br /> Section#:j„5 Town#:-38—N Range#:_L5_W Town o£ W o r,>() Z T 1)F0_,, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* i <br /> Parcel#(24 digits): (� <br /> Qz <br /> Tax ID#(1-5 digits): �oZ ` U a-7 ( Q y <br /> Property Site Address: r b-) 0 -Z-C'6eP 6 Lk i7 <br /> (.I-ra'n�' <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: j.to <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition )k Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(Iv) ❑ Camping Unit ❑ Commercial Acc. Addition W <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway <br /> C <br /> Proposed Structure/Addition Use: o-6 j R ne(1k- <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> Building Contractor: Master Plumber: Z 8 o tl 1�7 Y <br /> Anticipated Start Date: Z CT' <br /> Page 1 of 4 1--� <br /> Burnett County,WI Land Use Application—Rev 3/2016 �� <br />