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LAND USE PERNHT APPLICATION — Burnett County, WI <br /> y ^ 1 <br /> y ~ <br /> Permit Fees: ; Q� <br /> DwellingfPrincipal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> Dwellin rinci al Building-Multi-Family $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 <br /> AccessorySO <br /> Structure-Commercial Cl &Il $200 Addition to AccessoryStructure-Commercial Cl &11) $200 _ R <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/SidewalWDriveway& I <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(l v) $350 r. <br /> Camping Unit $100 Fillin Gradin $150 °^ <br /> Permit Extension Valid for one year-Only 1 Allowed $100 Boathouse $500 W <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. ' U) <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. ti <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. <br /> A Applicant Complete All Sections Below This Line o <br /> Applicant's Name: 1 1Cb444 4Q,. <br /> Applicant's Mailing Address: 21 Tiff <br /> City State Zip < <br /> �S (o8S <br /> Applicant's Telephone Number: -% 3235 <br /> Applicant's Email: o. <br /> �io�uc3 Q �- , <br /> t-t <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> []Letter hone ❑Email 5 <br /> w <br /> Legal Description: R <br /> N <br /> Lot#: CSM Vol. Pg. l32 OR rA <br /> Lot#: Block#: Subdivision Name: OR F ` <br /> Gov't Lot#: OR 1/4 1/4 ` 7 <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.* Y <br /> Parcel#(24 digits): p <br /> z 3 <br /> Tax ID#(1-5 digits): 52.&o <br /> p <br /> Property Site Address.Z ` j S411PQLAVC Io. V4JE rQVQL <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: s O <br /> ❑ Single Family Dwelling Ll Multi-Family Dwelling ❑ Filling/Grading 13 Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs )<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 /> W <br /> bv,`> � - lau ao >,��ro <br /> Proposed Structure/Addition Use: >`- vsf'-, �p C <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etcZ <br /> rl. tV rZ <br /> Building Contractor: ��.,.), . Master Plumber: Z <br /> }}�� � ti <br /> I�b � C <br /> Anticipated Start Date: �o <br /> Page 1 of 4 Z cm TTBurnett County,WI Land Use Application—Rev 3/2016 <br />