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LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> y. <br /> N <br /> Permit Fees: g c <br /> a <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Family $200 � O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to DwellingfPzincipal Building-Multi-Family $200 °^ <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) E <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial CI &Il $200 Addition to Accesso Structure-Commercial Cl &II $200 0 <br /> n <br /> Deck/Stairs/Patio/Retaining WalUSidewalk/Driveway& °< <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(l v)) $350 S <br /> Camping Unit $100 Filling/Grading $150 <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. w' <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 /> s - <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: a1 a Rcber4— <br /> Applicant's Mailing Address: 296-W3 I3e /.n ti.oB•A••- t a..: Sy893 b <br /> City State Zip <br /> y v <br /> Applicant's Telephone Number: 6/g.-919-P39 9 0 <br /> 0 <br /> w <br /> Applicant's Email: (3cbet4� Q.acicy P yn%r'- C.0� <br /> 1 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N °� <br /> El Letter }Phone ❑Email <br /> Legal Description: <br /> v 1 <br /> Lot#: CSM Vol.-Pg. 13 '2OR �' o <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: <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): d <br /> Tax 1D#(1-5 digits): y � <br /> Property Site Address: CO- 0 <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes <br /> Fee Rec: <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Mufti-Family Addition ❑ 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 <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway C <br /> Proposed Structure/Addition Use: <br /> (Ho abin;Commercial Business;Bedroom;De k etc.) Z O <br /> N N c-' <br /> Building Contractor: Master Plumber: Z 1 eJ u <br /> en r� <br /> Anticipated Start Date: G)0 c <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 3/2016 Z <br />