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LAND USE PERMIT APPLICATION — Burnett County, WI K <br /> N 1� <br /> G tT <br /> Permit Fees: <br /> Dwellin ,Princi al Build -Single Family $300 Addition to Dwellin Prurci al Building-Single Family $200 C <br /> Dwellin 1Princi al Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 n <br /> ContmerciaUlndustrial Building $300 Addition to Commercial Industrial Building $200 1 0 <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Ace Structure $150 Bunkhouse 5250 ; <br /> Accessory Structure Commercial Cl &11) 5200 Addition to Accessory Structure-Commercia((Cl &[1) S200 n <br /> Deck/Stairs.'Patio,7tetaining WalYSidewalk/Driveway& �. <br /> (Screenporches-in campgrounds only) $125 Gazebo(W I Stat 59.692(1 v)) 5350 t. <br /> Camping Unit $100 Filling/Grading SISO <br /> Permit Extension(Valid for one year-Only I Allowed) 5100 Boathouse <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. y <br /> *Items not listed above will be treated as acceysary structures.such as:perSOJIaS.landscaping,etc. <br /> Z <br /> Applicant Complete All Sections Below This Line 9 <br /> Applicant's Name: + 1 1 Ll I'1 <br /> Applicant's Mailing Address: <br /> ry State i <br /> Applicant's Telephone Number: C <br /> (// a - 03- 3�/� / �- <br /> v <br /> Applicant's Email: <br /> v <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. e <br /> ❑Letter []Phone 2<rnail <br /> Legal Description: <br /> 3 <br /> A4, - <br /> Lot#: CSM Vol. Pg. OR " rn <br /> Lot#: Block#: Subdivision Name: OR ° } <br /> Gov't Lot#: OR 1/4 1/4 I t } <br /> (�) <br /> Section#: Town#: N Range#: W Town of: c�TT lr <br /> *Attach additional page f f needed for lengthy description OR attach a copy of the deed OR attach tar system property page.* . <br /> Parcel#(24 digits): <br /> n z <br /> A <br /> Tax ID#(1-5 digits): <br /> d <br /> Property Site Address: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: SA-av <br /> ❑Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑Commercial Addition <br /> QLStairs•79)GAt4E:- O Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) U Camping Unit ❑ Commercial Acc.Addition <br /> ❑ Boathouse 0 Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway <br /> /�, <br /> Proposed Structure/Addition Use:��P 1C �)t/�7�i�✓ g279i.� iO :4fl E7 O <br /> /Home/C'a in;Com�nerciat Business;Bedroom:Deck:etc-) Z t. (�7 <br /> Building Contractor. 6/ AOL.�IZ -_4� &f— Master Plumber: 2 O o tl l�r tt <br /> Anticipated Start Date:f ZW APAWL-SZE- C (-:;' <br /> Page 1 of 4 <br /> 4 1 Burnett County,WI Land Use Application-Rev 3/2016 <br /> I �- 2!rc:r1U,j C=:� <br />