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LAND USE PERMIT APPLICATION — Burnett Count', WI a <br /> y H <br /> Permit Fees: $ ?� <br /> a <br /> Dwelling/Principal Building-Single Family 5300 Addition to DwellingTrincipal Building-Single Family $200 O <br /> Dwelling/Principal Building-Multi-Family 5300 Addition to Dwelling/Principal Building-Multi-Family $200 Z n <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 /> Accessory Structure-Commercial(Cl &I1) $200 Addition to Accessory Structure-Commercial(C1 &11) $200 <br /> 0 1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& °< <br /> (Screen orches-in campgrounds only) $125 Gazebo(WI Stat 59.692(l v)) $350 r <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Permit Extension(Valid for one year-Only 1 Allowed $100 Boathouse $500 a <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. <br /> •o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping, etc. r <br /> o " <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: r7C e 67–N 6:/er� 2l� <br /> H qo y G �C��'o ��I k'f� ��i ��f�>'o <br /> Applicant's Mailing Address: � ,- (��� l 4 <br /> City State zip < Z <br /> � y <br /> G <br /> Applicant's Telephone Number: <br /> -8 <br /> w <br /> Applicant's Email: <br /> b <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> []Letter rPhone ❑Email 0 <br /> Legal Description: <br /> Lot#: CSM Vol. Pg. OR <br /> /– I <br /> Lot#:��Block#: Subdivision Name: p-Aef ZnOR £ ) <br /> Gov't Lot#: OR 1/4 1/4 l ( 1 <br /> Section#: Town#:_/ N Range#:--/&—W Town o£ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 1\ <br /> Parcel#(24 digits): 47' 20 -OZ?000 <br /> Q� z <br /> Tax ID#(1-5 digits): / , ,'` , f y X <br /> Property Site Address: 3o2// / �/!i .e g e L4e 1df _At wl4 p, -r <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec ( l <br /> �❑ Ingle Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> Single Family Additionfd 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 W <br /> ❑ Boathouse ❑ Screen porch–campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway Cn <br /> w^n1 <br /> m <br /> l5 0u <br /> Proposed Structure/Addition Use: / –/J,! r <br /> (Home/Cnfiin;Commercial Business;Bedroom;Duck, etc.) <br /> n <br /> Building Contractor: Master Plumber: r 0 <br /> 0 <br /> C � <br /> Anticipated Start Date: Z u u u <br /> Page 1 of 4 <br /> Burnett County, WI Land Use Application—Rev 3/2016 <br />