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LAND USE PERMIT APPLICATION—Burnett County WI a <br /> Permit Fees: <br /> a 71 <br /> Dwelling/Principal Building-Single Family $300 Addition to DwellingfPrincipal Building-Single Family $200 C7 <br /> Dwellin rinci al Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> CommerciallIndustrial Building $300 Addition to Commercial/Industrial Building $200 Q OO O <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse $250 <'o <br /> Accessory Structure-Commercial Cl &II $200 Addition to Accessory Structure-Commercial CI &11 $200 j <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& —} o <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692 1 v) $350 v r <br /> Camping Unit $100 Fillin Gradin $150 ° <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 Boathouse $500 d <br /> 2 <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 /> */terns 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: <br /> Applicant's Mailing Address: r f/e cooSyQa o <br /> City State Zip o <br /> Applicant's Telephone Number:_ <br /> d <br /> Applicant's Email: 1e)rr\jk'&1U271 G -yi afI c Do <br /> b <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N � <br /> Letter Aphone ❑Email a <br /> w <br /> Legal Description: o <br /> y <br /> Lot#: CSM Vol. Pg. O\Rr i <br /> Lot#:�Block#: Subdivision Name: 1 N O't�rc- ��� OR ��,�J,V1 6 <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of:!�Z-l3 S (JJJ��tt`t <br /> I <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):�'a,'r Q5 <br /> Property Site Address: JV cz'n C,, s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:� <br /> L3 Single Family Dwelling L3 Multi-Family Dwelling ❑ Filling/Grading El Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition X Deck/Patio ❑ Commercial Addition <br /> XStairS ❑ 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-camoarounds only ❑ Retaining Wall ❑ Sidewalk/Driveway <br /> 1 \ 03 <br /> Proposed Structure/Addition Use: ��� / 5 r I-l o4 :4;,r, 1&,fL\ — I GL,Il�,Q- <br /> (Home/Cabin;Commercial Business;Bedroom;Deck:etc.) Z <br /> ONm <br /> Building Contractor: �� Master Plumber: Z { <br /> Anticipated Start Date: n pp- <br /> Page 1 of 4 l7 CO <br /> Burnett County, WI Land Use Application—Rev 3/2016 Z <br /> Q <br />