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LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> Permit Fees: g r a <br /> a Lo,` <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwellin Princi al Building-Sin le Family $200 a W <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $301L Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse $250 \ <br /> Accessory Structure-Commercial Cl &11) 0 Addition to Accessory Structure-Commercial(Cl &II) $200 '�\j ( rl <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& 1 <br /> (Screenporches-in campgrounds only) $125 Gazebo(WI Stat 59.692(ly) $350 1- <br /> Camping Unit I $100 Filling/Grading $150 ° <br /> Permit Extension Valid for one year-Only 1 Allowed $100 Boathouse $500 m <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. 0 <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. b <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r 0 <br /> o <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: 12 <br /> Applicant's Mailing Address: S I <br /> City State Zip C y <br /> Applicant's Telephone Number:- <br /> Applicant's Email: Q p1✓L0 -s4uT� �' Zal +� -'-�-f �' <br /> 1 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter Phone ❑Email e <br /> Legal Description: o <br /> N <br /> Lot#: iZ CSM Vol. 42 9- 77 OR St.) <br /> Lot#: Block#: Subdivision Name: OR ) <br /> Gov't Lot#: 4- OR 1/4 1/4 <br /> Section#:,ZZx:;, Town#:.4,I_N Range#: 1Z-=;- W Townof: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* / <br /> , <br /> Parcel#(24 digits): -,d>`7 -�S+ Z Z-�-1-1�a -?1s��' p'� _l��Z <br /> n z <br /> Tax ID#(1-5 digits): <br /> Property Site Address: ,4&57S! <br /> e <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 C <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition M <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Side/walk/Driveway N <br /> Proposed Structure/Addition Use: .�� s S,c� V A V, - 1 b - 0 � Z� v� � <br /> (Home/Cabin,-Commercial Business;Bedroom;Deck;etc.) Z O ry <br /> O_ <br /> Building Contractor: Master Plumber: C <br /> Anticipated Start Date: <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application-Rev 3/2016 <br />