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LAND USE PERMIT APPLICATION—Burnett County,WI 9 <br /> Permit Fees: `+ <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwelling/Principal Build' -Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Famil $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) i <br /> Addition to Arc,Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl&11 3100 Addition to Accessory Structure-Commercial Cl &11 $200 I� <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& j <br /> Screenporches-in campgrounds only) $125 Gazebo WI Stat 59.692(1 v) $350 S <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only I 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 /> v <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> o � <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: <br /> Applicant's Mailing Address: ( ST G`' N oawlx jflAI Sl 2� 3 ru <br /> City State zip <br /> �S1 - q y o <br /> Applicant's Telephone Number. 587 <br /> Applicant's Email: e-Q.t j1h `Q) a t (Gr Co vv.. <br /> If staff has a question about this application how do you prefer to be contacted'? Check one below. o w <br /> 81 �f0. LA � ❑Letter hone ❑Email '' <br /> Legal Description: <br /> __4Z &" C_y-t-cKso^ L0.N6 G Yanh6,,n WI 54840 <br /> y <br /> Lot#: CSM Vol. Pg. OR S' <br /> Lot#: Block#: _Subdivision Name: OR o <br /> Gov't Lot#: OR 1/4 _1/4 <br /> Section#: Town#: N Range#:_ W Town of: s " <br /> �1 <br /> *Attach additional page ifneeded for lengthy description OR attach a copy of the deed OR allach tax system property page.* t ^- U-+ <br /> Parcel#(24 digits): Imo+ <br /> m <br /> � z �-- <br /> Tax ID#(1-5 digits): a o ( <br /> Property Site Address: <br /> a <br /> TYPE OF PERMIT(S):Check appropriate box/boxes Fee Rec:f5 <br /> ❑Single Family Dwelling ❑ Mult:-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑Single Family Addition ❑ Multi-Family Addition ❑Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs �WAcc.Structure (Non-bunkhouse) ❑Bunkhouse ❑ Commercial Acc.Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑Camping Unit ❑ Commercial Aa.Addition <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway <br /> C .:. . <br /> Proposed Structure/Addition Use: G Q e-al le — - d i Al C 0 10 i M <br /> (Home/Cabin;Commercial Business; room;Deck;etc.) N <br /> M <br /> Building Contractor: a Gtr' Master Plumber: 0 k <br /> Anticipated Start Date: <br /> Pagel A) <br /> Burnett County,WI Land Use Application—Rev 3/2016 ] <br /> '5=5 <br />