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LAND USE PERMIT APPLICATION -Burnett County, WI a c <br /> Permit Fees: $ ?� <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwellin rinci al Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaVlndustrial Building $200 " O <br /> Accessory Structure(Non-Bunkhouse) —1� e <br /> Addition to Acc.Structure $150 Bunkhouse $250 W N <br /> Accessory Structure-Commercial(Cl &Il) $200 1 Addition to Accessory Structure-Commercial(C1 &Il) $200 1 �y <br /> C) ` <br /> Deck/Stairs/Patio/Retaining WalUSidewalk/Driveway& <br /> } 11 <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 I 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. b <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. c <br /> LL Applicant Complete All Sections Below ThisLineo <br /> Applicant's Name: L �✓ l� f l/� cL <br /> Applicant's Mailing Address: t♦ C SS p'X11 f e 14 VC <br /> // P City State <br /> State Zip <br /> ST `l111/ <br /> Applicant's Telephone Number: (D 3— t <br /> �v <br /> Applicant's Email: ES/U z( A P/Q 9 6 / ILL7 A62TIV/46 • CC) <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N w ji <br /> t <br /> [-]Letter Phone [-]Email <br /> ao <br /> Legal Description: o <br /> In <br /> Lot#:_ CSM Vol. Pg. OR s <br /> Lot#: Block#: Subdivision Name: o t � ~'S�"� OR y o <br /> I <br /> Gov't Lot#: OR 1/4 1/4 I ° <br /> Section#: Town#: N Range#: W Town of: I a <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* V <br /> Parcel#(24 digits): <br /> � z <br /> Tax ID#(1-5 digits): <br /> Property Site Address: <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: 5() .Te, <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 <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway <br /> C <br /> Proposed Structure/Addition Use: Z <br /> r (Home/Cabin; <br /> Commercial Buiness;Bedroom;Deck;etc.) <br /> Building Contractor: OAl( rZJ � V m <br /> N <br /> N <br /> Anticipated Start Date: CC rn <br /> Page 1 of 4 <br /> Burnett County, WI Land Use Application—Rev 3/2016 <br />