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LAND USE PERMIT APPLICATION —Burnett County, WI W <br /> b <br /> N ^ <br /> N <br /> Permit Fees: <br /> a <br /> DwellinglPrincipal Building-Single Family $300 Addition to DwellingfPrincipal Building-Single Family $200 O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Famii $200 <br /> Commercial/Industrial Building $300 Addition to Commerciallindustrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) ` E <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial C I &11) $200 Addition to Accessory Structure-Commercial C I&d 1 $200 <br /> n <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& ° <br /> Screenporches-in campgrounds only) 5125 Gazebo WI Stat 59.692(1 v $350 r <br /> Camping Unit $100 Filling/Grading Filling/GradingS150 ° <br /> Permit Extension Valid for one year-Only 1 Allowed SI00 Boathouse $500 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. w' <br /> *Communication Towers&Signs require a different application form,see corresponding application andfees. <br /> o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: r) 00—h I Lelaz <br /> 1 <br /> Applicant's Mailing Address: C(t , S <br /> City tate zip <br /> LoC)-'(' rk ° <br /> ° <br /> Applicant's Telephone Number: ° <br /> Applicant's Email: I 2 <br /> If staff has a question about this application how do you prefeVro be contacted? Check one below. N 00 <br /> 211'm 0 <br /> ❑Letter ❑Phonedail <br /> Legal Description: <br /> Lot#: CSM Vol. Pg. <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: �" OR 1/4 1/4 <br /> Section#: 9 - Town#:_9�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. <br /> Parcel#(24 digits): <br /> r, z <br /> Tax 1D#(1-5 digits): y a <br /> Property Site Address: `IOD rD 2_j e. 260— <br /> (Jon u� <br /> TYPE OF PERMIT(S): Check appro iatwboz/boxes Fee Rec: <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ M Id-Family Addition LlDeck/Patio Ll Commercial Addition <br /> C3 Stairs >2cc.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 /> Proposed Structure/Addition Use: �T 0r0 Qf�rA tf C �� <br /> (Home/ a in;Commerce ddBOiness;Bedroom;Deck:etc.) M <br /> Building Contractor: Master Plumber: Z <br /> Sr O m <br /> Anticipated Start Date:�l Z ] <br /> Page 1 of 4 f? 00 o <br /> Burnett County,WI Land Use Application—Rev 3/2016 C Q <br /> Z flJ <br />