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LAND USE PERMIT APPLICATION- Burnett County, WI Cr b <br /> Permit Fees: o <br /> a <br /> DwellingfPrincipal Building-Single Family $300 Addition to Dwellin rinci al Building-Single Fa $200 O <br /> Dwellin rinci al Building-Multi-Family $300 Addition to Dwellin rinci al Building-Multi-Famil 0 °^ <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 v O <br /> Accessory Structure(Non-Bunkhouse) E <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> AccessoryStructure-Commercial Cl &ll) $200 Addition to AccessoryStructure-Commercial Cl &II) $200 <br /> G1 <br /> Deck/StairstPatio/Retaining Wall/Sidewalk/Driveway& <br /> (Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(t v)) $350 r <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Permit Extension Valid for one year-Onl 1 Allowed $100 Boathouse $500 y <br /> 1 <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 /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: 4A (//Q jQf//VSOnI <br /> Applicant's Mailing Address: d 30-(9 f l( i4 416 S'O, Sa.s T.PuK /„it/ ,rS-&T s b <br /> City State zip < y # <br /> O y <br /> C <br /> Applicant's Telephone Number: 6,4/ 3 6_6 10") 9 c <br /> 0 <br /> w <br /> Applicant's Email: V,Yjc�Fl77C C CaMGAsT< U&-7- <br /> v <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N 00 <br /> ❑Letter [�f]Phone ❑Email /,_ // p <br /> Legal Description: <br /> } <br /> Lot#: CSM Vol. Pg. OR a <br /> Lot#: Block#: Subdivision Name: OR F <br /> Gov't Lot#: OR 1/4 1/4 j <br /> Section#: Town#: N Range#: W Town of: a 0 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): <br /> Property Site Address: 6 ,5-3/ )/'C:-/T DR. <br /> c <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> Ll Ingle Family Dwelling ❑ Multi Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> 31kSingle 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 /> Proposed Structure/Addition Use: ADD TD E7�/sr/N6 goo r2'_4 /D n /y N Z <br /> (Home/Cabin,Commercial Business;Bedroom,-Deck;etc.) 0 l� <br /> Z <br /> Building Contractor: Master Plumber: Z 0 <br /> G)O o �' <br /> Anticipated Start Date: C o <br /> Page 1 of 4 <br /> Burnett County, WI Land Use Application—Rev 3/2016 <br />