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LAND USE PERMIT APPLICATION -Burnett County, WI a _ <br /> N w <br /> H �1 <br /> Permit Fees: ?+ <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 DwellingfPrincipal Building-Multi-Family $200 UT1 <br /> Commercial/Industrial Building $300 Addition to CommereiaVlndustrial Building $200 O <br /> Accessory Structure(Non-Bunkhouse) E <br /> Addition to Ace.Structure $150 Bunkhouse $250 1 <br /> Accessory Structure-Commercial CI &II $200 Addition to ccessory Structure-Commercial(CI &Il) $200 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& < )I ;�� <br /> (Screenporches-in campgrounds only) $125 Gazebo(WI Stat 59.692(lv)) $350 c <br /> Camping Unit 5100 Fillip Gradin $150 <br /> Permit Extension(Valid for one year-Only 1 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. �d <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. e <br /> i Applicant Complete All Sections Below This Line o <br /> Applicant's Name: ✓o .1/, � �Cr I'1 rJ � / <eel <br /> Applicant's Mailing Address: /,3�d ��GSC li/ei G�. U4 JeV S07717 b <br /> c5 <br /> Ci State Zip y <br /> Applicant's Telephone Number: 7 <br /> r �t� 1�/ /�' /� / <br /> Applicant's Email: �J e 40 7hG G ,09,07✓07"D t.(� 6. , ✓n a <br /> J 1 <br /> 00 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. � 1 <br /> ❑Letter XPhone Got/ /,0/ <br /> ❑Email// <br /> Legal Description: S/y ��J R/y �G� Got/ `p T d <br /> w <br /> Lot#: CSM Vol. Pg. OR <br /> q' <br /> Lot#: Block#: Subdivision Name: OR AJo <br /> E <br /> Gov't Lot#: OR 1A 1/4 <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional page if neeeedded for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Parcel#(24 digits): O J702-1-12.711 5//y,SdcSUo/O/—?000 �r 1 <br /> Z d <br /> Tax ID#(1-5 digits): <br /> Property Site Address: <br /> 5�oen��i (,il <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rech <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> Single Family Addition ❑ Multi-Family Addition ❑ 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 aw <br /> ❑ Boathouse ❑ Screen porch—campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway <br /> Proposed Structure/Addition Use: Screen Pyrc4 N z <br /> O� <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) _z � Y 1�1 <br /> 2 C1 e" C = <br /> O `_ <br /> Building Contractor: � ��/— Master Plumber: ^^� <br /> /� Z—, uuu <br /> Anticipated Start Date: G (/J ,yriL/ 2,0 �j <br /> � <br /> Page 1 of 4 �--�—� <br /> Burnett County,WI Land Use Application—Rev 3/2016 �J <br />