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LAND USE PERMIT APPLICATION — Burnett County, WI ro <br /> Permit Fees: ~ <br /> a <br /> Dwelling/Principal Building-Sin le Family $300 Addition to DwellingiWiticipal Building-Single Family $200 a C7 <br /> Dwellin %Princi al Building-Multi-Family $300 Addition to Dwellin Princi al Building-Multi-Family $200 ( rti1 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200r� lVJ <br /> Accessory Structure(Non-Bunkhouse) r <br /> Addition to Ace.Structure 1 $150 Bunkhouse $250 <br /> Accesso Structure-Commercial(C1 &I I 0 Addition to AccessoryStructure-Commercial CI &11) $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> (Screen orches-in campgrounds only) $125 Gazebo(WI Stat 59.692(lv)) $350 <br /> r <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Permit Extension Valid for one year-Only I Allowed) $100 1 Boathouse $500 w <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. d' <br /> *Communication Towers&Signs require a different application farm,see corresponding application and fees. 7 <br /> ro �, <br /> *Items not listed above will be treated as accessog structures,such as: pergolas, landscaping, etc. <br /> r <br /> o '- <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: JA 0 `tom <br /> Applicant's Mailing Address: �� �, I� �f la 1/1 /tom{ f SLi�3i e <br /> City State Zip C <br /> i,,r o ter <br /> Applicant's Telephone Number: v J ' � 36 la�c a t, <br /> d <br /> ! d <br /> Applicant's Email: k <br /> ;I <br /> If staff has a question about thil pplication how do you er to be contacted? Check one below. N <br /> ]Letter one ❑Email <br /> Legal Description: O� �i Cyn. V 1-7 r10 V C'LA-l -t- 4: y4 <br /> Lot#: CSM Vol. ') Pg. OR <br /> s <br /> Lot#: Block#: Subdivision Name: OR I <br /> f <br /> Gov't Lot#: OR I/4 1/4 <br /> Section#: Town#: N Range#: W Town of: VJt <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): b-7 - C)2-0 - 2- <br /> Tax <br /> n z <br /> Tax ID#(1-5 digits): �( S <br /> �� 7 ) <br /> Property Site Address: S r�r�,r?� ��� � � t arL ,� <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> LlSingle Family Dwelling LI Multi-Family Dwelling ❑ Filling/Grading LlCommercial 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 Q <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway C <br /> �l� Z n <br /> Proposed Structure/Addition Use: � h)r A, ip, 4 ��t� M <br /> (ffo'n fico:Commercial Business;Bedroom;Deck;etc.) CSO <br /> (h� `' <br /> Building Contractor. l)�� _C-�V f>,J� Master Plumber. <br /> Anticipated Start Date: <br /> 3 I / 1 (a-7� Z �Iiu <br /> Pagel of 4 —� <br /> Burnett County, WI Land Use Application–Rev 3/2016 ��--� <br />