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LAND USE PERMIT APPLICATION— Burnett Countv, W! a _ <br /> N <br /> N �1 <br /> Permit Fees: a <br /> n <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-Family0 ITS i-- <br /> CommerciaUlndustrial Building $300 Addition to CommerciaUlndustrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure unkhouse $250 °co, <br /> Accessory Structure-Commercial C1 &Il) 0 Addition to Accessory Structure-Commercial Cl &ll) $200 \ <br /> Deck/Stairs/Patio/Retaining WalUSidewalk/Driveway& <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(lv)) $350 S <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 Boathouse $500 w <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. <br /> EY <br /> Applicant Complete All Sections Below This Line z <br /> Applicant's Name: M L-h e�i) Yyl it r r q t 11 <br /> Applicant's Mailing Address: 7 � <br /> City State zip <br /> O y <br /> C <br /> Applicant's Telephone Number: <br /> d <br /> Applicant's Email: MND- .MZ4r;t&4 /ale <br /> b \ <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N °G <br /> 0 <br /> ❑Letter ®Phone ❑Email <br /> 5' <br /> as � <br /> Legal Description: ,/g$2e if 9 4 ZI) o <br /> N <br /> Lot#: CSM Vol. Pg. OR <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 o£ 1 y <br /> *Attach additional page if needed far lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits): <br /> � z <br /> Tax ID#(1-5 digits): z <br /> Property Site Address: <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec <br /> amil i1y�welfing❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building �(z . <br /> i gle 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 � <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway C <br /> Z <br /> Proposed Structure/Addition Use: -O-A I,�C,/ i1 <br /> ,f�� E Z c <br /> (Home/Ca�bi}n:{�Commercial BusinBedroDe k et <br /> c.J r <br /> Building Contractor: "'dl "1Cga Plun�e(D <br /> Anticipated Start Date: I <br /> -f — b/ Z <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application —Rev 3/2016 :� n� <br />