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Cn <br /> LAND USE PERMIT APPLICATION- Burnett County VVI Cr ro r <br /> mPermit Fees a 8 ~ <br /> a � <br /> a <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Family $200 <br /> Dwellin rinci al Building-Multi-Family $300 Addition to Dwellin Princi al Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 O <br /> Accessory Structure(Non-Bunkhouse) E <br /> Addition to Acc.Structure $150 Bunkhouse $250 i <br /> Accessory Structure-Commercial(Cl &Il 0 Addition to Accessory Structure-Commercial Cl &11 $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 S <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only I Allowed $100 Boathouse $500 v <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. 9 <br /> */terns not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. a <br /> r <br /> y� Applicant Comp llOSections low This Line o <br /> Applicant's Name: / 1 © S <br /> Applicant's Mailing Address: I l <br /> 1 '7(* <br /> Y)INCity z <br /> `7G( l � o_ 2 <br /> Applicant's Telephone Number: l �V — <br /> Applicant's Email: <br /> ro <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N °� <br /> ]Letter hone Email Ua' '- <br /> 7� (� <br /> Legal Description: CSM 1 tJ b D G 5© 1-1 Q <br /> 5 U+ S f g U Cu'tt G <br /> Lot#: CSM Vol. 1'9_Pg.�_ OR �' y <br /> Lot#: Block#: Subdivision Name: OR Imo) o <br /> Gov't Lot#: OR 1/4 1/4 p r 1 <br /> Section#: 20o_Town#: 3t9 N Range#: L � W Town of: <br /> *Attach additional page if neededfor lengthy description OR attach a1crop-y of the depend OR attach tax system property page.* <br /> (b 1 <br /> Parcel#(24 digits): 1 ` b Tl `Z 3 l�p O ` 04-006-61_3 5 <br /> Z t7 <br /> Tax ID#(1-5 digits): I N <br /> Property Site Address: XXX l�� Q C I r l `'-eho n 1 V `r <br /> s I op <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: ls� <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(1v) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway W <br /> Proposed Structure/Addition Use: ?o' aI l — 1 0 Z c B u u <br /> G (Nome/Cabin; fm�mercciat Business;Be oom;Deck;etc.) IV M <br /> Building Contractor:5��r m Q n VVl Master Plumbe : _Z Jnr <br /> Anticipated Start Date: ` t / tp Gn Q o_ <br /> Page 1 of 4 Z Q <br /> Burnett County,WI Land Use Application—Rev 3/2016 :� �/ <br />