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LAND USE PERMIT APPLICATION —Burnett County, WI <br /> a � <br /> Permit Fees: ; a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 m <br /> m <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 O <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Ace.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &Il $200 Addition to Accessory Structure-Commercial CI&Il $200 Sb <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> (Screenporches-in campgrounds only) $125 Gazebo Stat 59.692(Iv) $350 S <br /> Camping Unit $100 Filling/Grading Filling/Grading $150 <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 Boathouse $500 C <br /> m <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. 9 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: <br /> Applicant's Mailing Address: = > <br /> / City State Zip < <br /> Applicant's Telephone Number: (s�FJ� -�6r1 <br /> 0 <br /> Applicant's Email:._ ..% >,pyr�N iv l'LIQ•eAt✓ <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> w <br /> ❑Letter Phone ,Email a• <br /> Legal Description: <br /> Lot#: CSM Vol. Pg. OR <br /> 5. <br /> Lot#: a Block#: Subdivision Name: S > OR o <br /> Gov't Lot#: OR 1/4 1/4 <br /> , ' <br /> Section#:. 3a_Town#: 1' NRange#:�W Town of: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* F+ <br /> CO-aZ -"Z- g0-15-ZZ 5 15= nay � r <br /> Parcel#(24 digits): 2 �' O � g <br /> Tax ID#(1-5 digits): ����J�S ,,�� v ��� (� r X <br /> Property Site Address: �/IL�I IWX oc,� �-S k�/1kU`� wi <br /> i \JW <br /> la <br /> TYPE OF PERMrT(S): Check appropriate box/boxes Fee Rec: 1@,5 <br /> ❑Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑Single Family Addition ❑ Multi-Family Addition A Deck/Patio ❑ Commercial Addition <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 ❑ Sidewalk/Driveway <br /> Proposed Structure/Addition Use: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc) *Z <br /> � r z <br /> Building Contractor: �����.1 ���� Master Plumber: <br /> Anticipated Start Date: 7/�J Q 1 LD <br /> Pagel of 4 C is <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />