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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> ON <br /> Permit Fees: a 9 1 <br /> Dwelling/Principal Budding-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 a WW <br /> Dwelling/Principal Building-Multi-Family $300 Addition to DwellingfPrincipal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciallIndustrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) i <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial CI&Il $200 Addition to Accessory Structure-Commercial Cl &11) $200 <br /> 0 a <br /> Deck/StaimTatio/Retaining Wall/Sidewalk/Driveway& <br /> (Screen orches-in campgrounds only) $125 Gazebo(Wl Stat 59.692 lv $350 r <br /> Camping Unit $100 Fillet Gradin $150 ° <br /> Permit Extension(Valid for one year-Only 1 Allowed $100 Boathouse $500 v, <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. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. fD _ <br /> jjApplicant Complete All Sections Below This Line o <br /> 50 <br /> Applicant's Name: ./l?Ct N W C V IE ►^ {� <br /> Applicant's Mailing Address: ?/T LJ&s-r 5 t sr /'/�f'S �/�/ <br /> l Z ss-wo ro <br /> citj State zip C <br /> O y <br /> Applicant's Telephone Number: <br /> Applicant's Email: O-W iL5 1,,, /1& F c-} i. L C O W) <br /> b <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. o w 1 <br /> Letter (Phone Email <br /> Legal Descri tion: o <br /> Lot#: CSM Vol. g. rc 5 OR a, <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#:_�2_OR 1/4 1/4 <br /> Section#: Town#: 44 1 N Range#: / $� W Town of: .Sw ;S y <br /> *Anach 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): <br /> Property Site Address:_ 74 f!jo` L cr l;� D t- <br /> TYPE OF PERMIT(S): Check appropriate box/boxes 4 <br /> FeeRec: <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs A Acc.Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(1v) ❑ Camping Unit ❑ Commercial Acc.Addition to <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway C <br /> Proposed Structure/Addition Use: x'a- S�cr m �u �, 0 <br /> ( ome/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> Building Contractor: T"p,.. 4 Qi J u Master Plumber: Z o p <br /> Anticipated Start Date: <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 3/2016 �� <br />