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LAND USE PERMIT APPLICATION — Burnett County, WI a b <br /> Permit Fees: <br /> a <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Family $200 � C7 <br /> DwellingfPrincipal Building-Multi-Family $300 Addition to DwellingTrincipal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) l <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &II $200 Addition to A cessory Structure-Commercial Cl &I1) $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(lv) $350 S <br /> Camping Unit $100 Fillin Gradin $150 <br /> Permit Extension Valid for one year-Only I Allowed) $100 Boathouse $500 <br /> a <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 /> b <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> ((�� <br /> I -Applicant Complete All Sections Below This Line o <br /> Applicant's Name: arl, q <br /> 1--eIr 1146* Uri <br /> Applicant's Mailing Address: 7 Io SU ��� (✓ 5 375 ! t t, SS �( S b <br /> City State zip < # <br /> Applicant's Telephone Number: 2L(2– X7 3F3 c a <br /> f d <br /> Applicant's Email: LA NCa t�►1/[; �it � y tJ�)AAki 6 p <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N °� <br /> ❑Letter OPhone ❑Email <br /> 5' <br /> on <br /> Legal Description: d <br /> H <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR QJ o <br /> Gov't Lot#: 7 OR 1/4 1/4 l <br /> Section#: �[3 Town#: 40 N Range#:--A_W Town o£ dA-� (4 puql y <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 1 <br /> Parcel#(24 digits): x <br /> Tax ID#(1-5 digits): <br /> Property Site Address: �0 cy' <br /> TYOF PERMIT(S): Check appropriate box/boxes Fee Recti) <br /> Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building � <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs d 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 /> �ce,thc�Q Z V <br /> Proposed Structure/Addition Use: ""..Q N MZ m� <br /> ,,me/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> ALA / Z <br /> Building Contractor: AMA owsk do-A-7 Master Plumber: � 1 2 n —. <br /> G)O <br /> Anticipated Start Date: lb-1– 1(o � ,) <br /> Page 1 4 <br /> Burnett County,WI Land Use Application—Rev 3/200 16 <br />