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LAND USE PERMIT APPLICATION— Burnett County, WI a b <br /> N �1 <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwellin rinci al Building-Single Family $200 C7 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 i <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 O <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &Il $200 Addition to Accessory Structure-Commercial Cl &Il) $200 6 <br /> 6 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& ° 1 <br /> Screenporches-in campgrounds only) $125 Gazebo WI Stat 59.692 Iv) $350 r, <br /> Cam in Unit $100 Filling/Grading $150 ° <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 Boathouse $500 <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. Qv <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. <br /> S <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: J e ryir A L M I.ST <br /> Applicant's Mailing Address: 3 I I S 3 l.l. BASS L K. Ql7/17th W oleftr Qr ? <br /> cityState Zip Z <br /> Sq•93C <br /> Pl? p �� I S 3'7 I — l MS4O a <br /> Applicant's Telephone Number: n. <br /> d <br /> Applicant's Email: iN A <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N w <br /> ❑Letter Phone ❑Email <br /> ao I <br /> Legal Description: v <br /> N <br /> Lot#: CSM Vol. Pg. OR a <br /> Lot#: Block#: Subdivision Name: OR o 1 <br /> Gov't Lot#: OR 1/4 1/4 1 ° 1 <br /> Section#: Town#: N Range#: W Town of: `� d <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: <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: )�J <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ 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 /> L3 Boathouse Ll Screen porch—campgrounds only 13 Retaining Wall ❑ Sidewalk/Driveway C 0 <br /> ❑7 �UI <br /> Proposed Structure/Addition Use: 121EG1C o m C <br /> (Nome/Cabin;Commercial Business;Bedroom;Deck;etc.) F� <br /> Z <br /> Building Contractor: Sp4-S= &I LC2 Master Plumber: Z n ~' <br /> G) 0 o C <br /> Anticipated Start Dater• ' I(s Z o <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 3/2016 :� �� <br />