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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> y " 1 <br /> Permit Fees: a ?` <br /> DwellingfPrincipal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> Dwelling/Principal Building-Multi-Famih $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaUIndustrial Building $200 <br /> Accessory Stnicture(Non-Bunkhouse) f <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial C1&11 $200 Addition to Accessory Structure-Commercial Cl&11) $200 <br /> Deck/Stairs(Pa6o/Retaining WalUSidewalk/Driveway& <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692 lv $350 r <br /> Camping Unit $100 Fillin Gradin $150 o <br /> Permit Extension Valid for one year-Onl 1 Allowed) $100 Boathouse $500 J <br /> m <br /> 7 <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 andfees. y <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. <br /> /J� Applicant Complete All Sections Below This Line o <br /> Applicant's Name: /I IGt y k N2 kn <br /> ,r by, p n <br /> Applicant's Mailing Address: t��7 �/ l/ . a, �f s <br /> Lorrcts!G'. <br /> !, City State zip < z <br /> Applicant's Telephone Number: 7 S -7 3 3 60 <br /> LLQ o <br /> Applicant's Email: l r�/►Q Ir�—�� le,VIQ Z-L (/ V(,t � lh✓t <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N °� <br /> ❑Letter *hone ❑Email <br /> o� <br /> Legal Description: <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 l <br /> Section#: Town#: N Range#: W Town of: L4 �� <br /> H <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tar system propertypage. <br /> Parcel#(24 digits): x <br /> Tax ID#(1-5 digits): <br /> Property Site Address: <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:15), <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 03 <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(iv) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> ❑ Boathouse ❑ Screen porch—campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway N C <br /> Proposed Structure/Addition Use: eT4g C _ —1 � <br /> �lf <br /> t ' r� <br /> (Home/Cabin; ommercia!Business;Bedroom;Deck;etc.) 7 r� <br /> o o <br /> Building Contractor: I7 Master Plumber: <br /> Anticipated Start Date: S� /(f <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />