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_t LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Permit Fees: T o� <br /> 6 <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Familyi t\$200 � t7 <br /> DwellinglPrincipal Building-Multi-Famil $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse $250 y <br /> Accessory Structure-Commercial Cl &11) $200 Addition to Accessory Structure-Commercial(C I fi I) $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& o <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(l v)) $350 r <br /> Camping Unit $100 Filling/Grading $150 °^ <br /> Permit Extension Valid for one year-only I Allowed) $100 Boathouse $500 <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 /> 'v <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: N Ry 's (.t.) -P 1) 5 <br /> Applicant's Mailing Address: t)rl h :50 h C(,I<V 1\d W45 <br /> City State Zip # <br /> Applicant's Telephone Number: --) 5 ' 5 1-7 3 C�0 t j o c <br /> d <br /> Applicant's Email: -e A 5 6 n M%�h 0 U 11n <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N b <br /> a <br /> ❑Letter Whone ❑Email 7 <br /> Legal Description: R <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR �j o <br /> l"r�l <br /> Gov't Lot#: OR 1/4 1/4 1 <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): <br /> � z <br /> Tax ID#(1-5 digits): y <br /> Property Site Address: a-A0 <br /> a Jy h n 5 11 L( 1< ll <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:LQD6 M) <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs XAcc. 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 C <br /> Proposed Structure/Addition Use: Q Oty,C401 Z <br /> _hh (Home Cabin;Commercial Business;Bedroom;Deck;etc.) 0 fn <br /> Building Contractor:N Ul`� G'Rd I V:3 Ld Master Plumber: 9 -1 <br /> ca <br /> Anticipated Start Date: 9 -kb 1a <br /> C rn <br /> Page 1 of 4 Z <br /> Burnett County,WI Land Use Application—Rev 3/2016 -G �` <br />