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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> n <br /> Permit Fees: O1 <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> DwellinglPrincipal Building-Multi-Family $300 Addition to Dwellin rind al Building-Multi-Famil $200 <br /> Commercial/Industrial Building $300 Addition to Commercialiladustrial Building $200 O <br /> Accessory Suucture(Non-Bunkhouse) a <br /> Addition to Acc.Structure $1 Bunkhouse $250 1 q <br /> Accessory Strucutre-Commercial Cl &Il $200 1 Addition to Accessory Structure-Commercial(Cl&Il) 5200 <br /> Gt i <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& °< <br /> (Screen orches-in campgrounds only) $125 Gazebo(WI Stat 59.692(lv)) S350 r <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 Boathouse $500 L <br /> 2 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three limes the normal fee. d <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treated us accessary structures,such as:peygolas,landscaping, etc. — <br /> Applicant Complete All Sections Below ThisLine a <br /> Applicant's Name: lC �� d f` I C t f14 <br /> Qn <br /> Applicant's Mailing Address: 1DN e <br /> Citytate_ Zip C y <br /> 02(0 7 y� S ,677 ° �1 <br /> Applicant's Telephone Number: <br /> a <br /> Applicant's Email: j C' 1 n)C C j i✓t 5 & A CSL_ , C 0 0� <br /> G b I <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> QLetter 2fhone 2(&[t.fmail <br /> Legal Description: P C-L-S I t`l 6 Q VCIZ <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 <br /> �J <br /> Section Town#:�N Range#:_ f _W Town of: T�' U e- L PA W-V <br /> 1 <br /> *Attach additional page ifneededfor lengthy description OR attach a copy ofthe deed OR attach tax system property page. <br /> `J <br /> r <br /> Parcel#(24 digits): 07 - 03q-d-- 37 'J?713 -5' ` US" 00 i Q .1y U00 O <br /> Tax ID#(1-5 digits): c4-ILA 5 1 <br /> � <br /> ° <br /> Property Site Address: � 1 ACC- r-Zf R1 <br /> c <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 ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit E)dension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway C <br /> Proposed Structure/Addition Use: / O!C S t d / �6r� Z F <br /> (HomtXabin;Commercial Business;Be(room;Deck;etc.) © --'I <br /> I <br /> Building Contractor: Master Plumber: Z -a <br /> N <br /> Anticipated Start Date: /(S <br /> Page 1 of 4 Z � !� <br /> Burnett County,WI Land Use Application—Rev 3/2016 4 <br />