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LAND USE PERMIT APPLICATION —Burnett County, WI Cr b <br /> m <br /> 1� <br /> Permit Fees: o� <br /> 0 <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Family $200 � C7 <br /> DwellingfPrincipal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 ^ <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) E <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(Cl &11) $200 Addition to Accessory Structure-Commercial C I & I 1 $200 <br /> L] <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(l v) $350 r <br /> Camping Unit $100 Filling/Grading $150 °^ <br /> Permit Extension Valid for one year-Only 1 Allowed $100 Boathouse $500 d <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 /> s - <br /> Applicant Complete 'All Sections Below/ Q <br /> This Line o <br /> Applicant's Name: �tJ�L` C� f���� L Be-_L <br /> Applicant's Mailing Address: `1 R ► 1'!�� Ay N uJ of fR lb hlTb SSI I <br /> City State Zip < # <br /> O_ y <br /> Applicant's Telephone Number: !!o SI -(P33 -- 770K <br /> a t <br /> Applicant's Email: <br /> I Kntx��� W15h . L' Cr►'1 <br /> b 4-- <br /> SJ <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. 0° <br /> ❑Letter Phone ❑Email <br /> w <br /> Legal Description: SZk A JVC i4 f-D o <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 l <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage.* I <br /> Parcel#(24 digits): <br /> � z <br /> Tax ID#(1-5 digits): y <br /> Property Site Address: <br /> s <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/Patio ❑ Commercial Addition <br /> ❑ Stairs X 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 /> N�17 Fr�R sTneA�� N <br /> Proposed Structure/Addition Use: 2 <br /> 1 (� (Nome/Cabin;Commercial Business;Bedroom;Deck;etc.) Z t, ,,i <br /> Building Contractor: J - L U IIL 0Fl?S Master Plumber: ��� Z <br /> Anticipated Start Date: 9 - 16 G)G <br /> Page 1 of 4 � <br /> Burnett County,WI Land Use Application—Rev 3/2016 �� <br />