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LAND USE PERMIT APPLICATION—Burnett County* WI <br /> y 1 <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwellin ci al Building-Single Family $200 / <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwell' rinci al Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial4ndustrial Building $200 4-- <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Ace.Structure SI unkhouse $250 1 t <br /> Accessory Structure-Commercial Cl&Il $200 Addition to Accessory Structure-Commercial(Cl&Il $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& o ` [� <br /> Screenporches-in campgrounds only) $125 Gazebo WI Stat 59.692 lv S350 ll� <br /> Camping Unit 5100 Filling/Grading $150 <br /> Permit Extension(Valid for one year-only I AllowedL S 100 Boathouse �qpp <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. b <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> s <br /> -�- Applicant Complete All/Sections Below This Line o <br /> Applicant's Name: �^ J(�.SC�O <br /> Applicant's Mailing Address: 7_3916 T-50 IA w� d A 1«I .S/dtp rt W4 SVT <br /> C� City State Zip < ,� <br /> PP Telephone 3 i Z <br /> Applicant's Tel hone ' � a <br /> 0 <br /> Applicant's Email: <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N b \ l3J <br /> ❑Letter [hone ❑Email 7 1 I <br /> w <br /> Legal Description: C <br /> Lot#: CSM Vol. _Pg. 16 OR y 1 <br /> Lot#: Block#: Subdivision Name: OR o <br /> Gov't Lot#: OR 1A 1/4 1 UI g <br /> Section#: Town#: N Range#: W Town of:__tX�y {Ls y <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Parcel#(24 digits): C277-00C-24 -3K-1-7-145-1 03 0JO"d1 AT 9� <br /> Z <br /> Tax ID#(1-5 digits): Z(Z <br /> Property Site Address: 2,3911v f-MbdAd-V 1�1� <br /> e <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Pabo ❑ Commercial Addition <br /> ❑ Stairs CK.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: Qr, c //^ � _ C <br /> (Ho abm;Commercial Business;Bedroom;Deck:etc.) on. <br /> Q <br /> Building Contractor: l��t�b t tt5�lo�pWk#'5 Master Plumber: <br /> J <br /> Anticipated Start Date: n ry <br /> Page 1 of 4 C <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />