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LAND USE PERMIT APPLICATION - Burnett County, WI a ro <br /> N �1 <br /> Permit Fees: xr <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 a <br /> d <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciallIndustrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) �O <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(Cl &II) $200 Addition to Accessory Structure-Commercial C I &I1 $200 <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 $500 <br /> m <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. d' <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. r <br /> o <br /> —�( Applicant Complete All'Sections <br /> Below This Line o <br /> Applicant's Name: �J C y�r� �r� Ct ,LAV* U V' lCyAJ//�� <br /> Applicant's Mailing Address: JZ O/o C D Pei C I��A Lk-A WVS �h�$i6 � � <br /> —7 City State zip x <br /> Applicant's Telephone Number: <br /> d <br /> Applicant's Email: <br /> Ski <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N °q <br /> ❑Letter ®Phone ❑Email 0. <br /> as <br /> Legal Description: d <br /> Lot#: CSM Vol. 21r�Pg. OR <br /> Lot#: Block#: Subdivision Name: OR o <br /> Gov't Lot#: OR 1/4 1/4 1 <br /> d <br /> Section#: Town#: N Range#: W Town of: ti <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> r � <br /> Parcel#(24 digits): <br /> 33 6l z <br /> Tax ID#(1-5 digits): <br /> Property Site Address: Kok— <br /> TYPE <br /> ok -TYPE OF PERMIT(S): Check appropriate box/boxes s apo <br /> Fee Rec: <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> Single Family Addition ❑ Multi-Family Addition V3 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 C <br /> LlL3Boathous ❑ Screen porch—campgrounds only Retaining Wall ❑ Sidewalk/Driveway <br /> Np-� Lam.Se n..4 Aga, ,�r <br /> Proposed Structure/Addition Use: _ N Z z r� <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;btc.) O �J <br /> Building Contractor: a,: Master Plumber: W G c� I`v�slno�y� Z O r'' <br /> Anticipated Start Date: <br /> k! G) o <br /> Page 1 of 4 Z <br /> Burnett County, WI Land Use Application—Rev 3/2016 4 C� <br />