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* LAND USE PERMIT APPLICATION —Burnett County, WI *c <br /> ro <br /> Permit Fees: _ o� <br /> R <br /> DwellingfPrincipal Building-Single Family $300 Addition to Dwellin rinci al Building-Single Family $200 U <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 / <br /> Commercial/Industrial Building $300 Addition to CommerciaUlndustrial Building $200 �Ir}11 y)1 0 <br /> Accessory Structure(Non-Bunkhouse) 8 <br /> Addition to Acc.Structure $150 Bunkhouse $250 y <br /> Accessory Structure-Commercial Cl &II $200 Addition to Accessory Structure-Commercial Cl &11) $200 <br /> o <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& � <br /> Screen orches-in campgrounds only) $125 1 Gazebo WI Stat 59.692(l v)) $350 C <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Permit Extension Valid for one year-Only 1 Allowed) 1 $100 Boathouse $500 y <br /> m <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. <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: ;2,4't Kot v,EL <br /> a S6sS <br /> Applicant's Mailing Address: Q/1 3s (it/Q ds>- w.� <br /> City State Zip X # <br /> X <br /> Applicant's Telephone Number: -71s' O d6G- 1674/ c. <br /> 0 <br /> Applicant's Email: Ja N �rt2va0i`�e4?S`r. Coww <br /> o <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> ❑Letter ❑Phone t5aEmail 9. <br /> as <br /> Legal Description: o <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR E <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: y <br /> *Attach additiona/page if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertypage.* , <br /> Parcel#(24 digits):. <br /> Z <br /> Tax ID#(1-5 digits): y a <br /> Property Site Address: 'SG SS Old 357 S-y9fP3 <br /> s i� <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: I te—th <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs 3Z Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition <br /> Q Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway C <br /> Proposed Structure/Addition Use: , a�t N � cC� <br /> (Home/Cabin:Commercial Business:Bedroom:Deck:etc.) <br /> Building Contractor: AAbr0QA*j Master Plumber: <br /> 2 <br /> Anticipated Start Date: yf�2���6 <br /> 0 c� <br /> g�•1 <br /> Page 4 � u <br /> Burnett County, WI Land Use Application—Rev 3/2016 <br />