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_LAND USE PERMIT APPLICATION— Burnett CountyWI a r <br /> a C <br /> Permit Fees: 4 <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwellin rinci al Building-Single Family $200 a <br /> \ l <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwelling/Principal Buildingt7 <br /> -Multi-Famil $200 l 1 v J <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 v\ <br /> Accessory Structure(Non-Bunkhouse) <br /> 1 <br /> Addition to Acc.Structure $150 Bunkhouse $250 s) <br /> Accessory Structure-Commercial CI&Il $200 Addition to Accessory Structure-Commercial (CI & I11 $200 <br /> Deck/Stairs/Patio/Retaining WalUSidewalk/Driveway& <br /> Screen orches-in campgrounds only) j <br /> $125 Gazebo WI Stat 59.692 lv) $35pCamping Unit $100 Filling/GradingG 5 <br /> $150 <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 Boathouse $gpp <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 £ z <br /> F� <br /> 0 <br /> Applicant's Name: [U t4 �—� It t � <br /> Applicant's Mailing Address: W Q 3& S4�A :R 4c b-t I sr 5qoa 1 '110 <br /> City State Zip < # <br /> Applicant's Telephone Number: bS ( - 35 6-1 - qa I c a d <br /> d <br /> Applicant's Email: 0 <br /> ro W <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N Q� <br /> a t <br /> See. <br /> ,� <br /> IRLetter ❑{eTP ne ❑Email w n J <br /> Legal Description: �JIB!. 3 U 71' <br /> Lot#: CSM Vol. Pg. OR S <br /> W <br /> Lot#: Block#: Subdivision Name: OR o r <br /> Gov't Lot#: OR 1/4 1/4 1 <br /> t <br /> Section#: Town#: N Range#: W Town of: LA <br /> Parcel <br /> additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* L O <br /> Parcel#(24 digits): q, <br /> Z <br /> t <br /> Tax ID#(1-5 digits): <br /> Property Site Address: 6 3S �� ` Dr, <br /> � Q <br /> v t <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> El Single Family Dwelling ❑ Multi-Family Dwelling L3Filling/Grading L3 Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> Stairs IN 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 /> /^ t • r' <br /> Proposed Structure/Addition Use: 6 2 .S m a-t 6Qq rS rto "6 - r nI %ed --�Ot "UT00 <br /> Home/Cabin;Commercial Business;Bedroom;Deck;etc.) G� <br /> ri�b <br /> Building Contractor: �h n5,d C.6t4I _d/eti. Master Plumber: F— -_ -�ri cl «.7 0 <br /> Anticipated Start Date: c j <br /> � rn <br /> Page 1 of 4 <br /> Burnett County, WI Land Use Application—Rev 3/2016 <br />