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LAND USE PERMIT APPLICATION — Burnett CountyWI 5- b <br /> Permit Fees: <br /> Ir 71 <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Familya <br /> $200 ;` C7 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to DwellingfPrincipal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse $250 'm <br /> Accessory Structure-Commercial CI &Il) $200 1 Addition to Accessory Structure-Commercial Cl &II) $200 ~ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& o ! <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(l v)) $350 r <br /> Cam in Unit $100 Filling/Grading $150 o <br /> Permit Extension Valid for one year-Only 1 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 /> 0 <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: Q Ir ru ill Q 7 G h <br /> Applicant's Mailing Address: ` Z [ 9 COGS n G, i't ���jx„�y UJt 500 � b <br /> City State Zip < <br /> O_ y <br /> Applicant's Telephone Number: 7/ <br /> d <br /> w <br /> Applicant's Email: <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> 0 <br /> Leger Phone ❑Email <br /> t °C <br /> Legal Description: 4014 R <br /> y <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR ,, o <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional page i needed or lengthy description OR attach a co o the deed OR attach tax system property page.* 8 <br /> P g .1� f gY P PY /� Y P P tYPg <br /> Parcel#(24 digits): v 1 <br /> O <br /> Tax ID#(1-5 digits): <br /> Property Site Address: 4 <br /> S <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:a�m.� <br /> )4 Single Family Dwelling ❑ Multi-Family Dwelling LlFilling/Grading Ll 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(ly) ❑ Camping Unit ❑ Commercial Acc. Addition <br /> ❑ Boathouse ❑ Screen porch—campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway c <br /> X n <br /> // JL� <br /> Proposed Structure/Addition Use: JC f C'e h m tk t V Y1 C157"ioi`i T 4-K iV M <br /> (Home/Cabin; ommerciat Business;Bedroom;Deck; tc.) <br /> Building Contractor: Kh,vo /�_ Master Plumber: o <br /> Anticipated Start Date: AI}� 4 t �' Z T <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 3/2016 �0 <br />