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LAND USE PERMIT APPLICATION- Burnett CounpNIWIPU R/S ANEO0. c <br /> N » <br /> Permit Fees: <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Family $200 �7 aC <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family— $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaVlndustrial Building $200 O <br /> Accessory Structure(Non-Bunkhouse) E <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &I 1 $200 1 Addition to Accessory Structure-Commercial(Cl &II) $200 sb <br /> 0 <br /> Deck/Stairs/Pafio/Retaining Wall/Sidewalk/Driveway& � ( <br /> Screen orches-in campgrounds only) $125 Gazebo Wl Stat 59.692 lv) $350 <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. 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: C <br /> C n <br /> Applicant's Mailing Address: b C7` b <br /> // j m�pls.�itym� � g tA Zip a N z <br /> Applicant's Telephone Number: 0 I Q- Z3�/ J a <br /> d <br /> Applicant's Email: r p E) `L-COM. <br /> If staff has a question about this application ow do you prefeZ be contacted? Check one below. N b <br /> ❑Letter Phone [mail <br /> Legal Description: {' Q\�(� d <br /> y <br /> Lot#: CSM Vol. Pg. OR <br /> ZJ <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 <br /> }}JJ = <br /> Section#: Town#: N Range#: W Town of <br /> 1 <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): F <br /> Tax ID#(1-5 digits): <br /> Property Site Address: a s 11(Z� <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:0 ')D <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(Sv) ❑ Camping Unit ❑ Commercial Acc. Addition W <br /> ❑ Boathouse ❑ Screen porch—campgrounds gnly ❑ Retaining all ❑ Sidewalk/Driveway C <br /> Proposed Structure/Addition Use: �.� ► jZOd 1\ I — '1i <br /> (Home/ abin;C" mer ' t Business;Bedroom Deck;etc.) 'S Z ); <br /> Building Contractor: <br /> Master Plumber: Z 0 r <br /> N?� ^� 2 Z <br /> Anticipated Start Date: y d <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />