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LAND USE PERMIT APPLICATION —Burnett County, WI 5,- <br /> r <br /> b <br /> rn <br /> Permit Fees: c er <br /> Dwellin %Princi al Building-Single Family $300 Addition to Dwellin ./Princi al Building-Single Family $200 d <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial,Industrial Building $200 O <br /> Accessory Stmcture(Non-Bunkhouse) <br /> Addition to Ace.Structure $150 Bunkhouse $250 Q ) <br /> Accessory Structure-Commercial(C1 &11) $200 1 Addition to Accessory Structure-Commercial(Cl &11 $200 , Z` <br /> Deck/StaiIs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> (Screen orches-in campgrounds only) $125 Gazebo(WI Stat 59.692(lv)) $350 <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 Boathouse $500 <br /> r � <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 /> *Items not listed above will he treated as accessorystructures,such as:pergolus, landscaping, etc. ` <br /> Applicant Complete All Sections Below This I 'meo <br /> Applicant's Name: /8"1,�// l cNeI,9C Z�VfqtF <br /> Applicant's Mailing Address: /?3o K440 g4drzt flid WZf o <br /> City tate Zip c <br /> Applicant's Telephone Number: tea 5/ z 70 <br /> o l <br /> Applicant's Email: 1(-2 k f e_yK e_✓ fe ►/`V t C ✓1 e <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> ❑Letter ]Phone Email <br /> Legal Description: a / PL A--r 6 IJ#/'s /'✓raj OF e<�/� R/T <br /> Lot#: CSM Vol. Pg. OR [ /9 At 4;- <br /> Lot <br /> ;Lot#: Block#: Subdivision Name: OR o <br /> Gov't Lot#: OR 1/4 1/4 l <br /> Section#: Town#:37!!�_N Range#: I W Town of: /c%wAl 4 P 7�44©C 1_4wtr 1 - <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): 07 '63 37 <br /> Ca 7 <br /> Tax ID#(1-5 digits): �� lJ <br /> Property Site Address: ,2 D� I I I 111Ocll <br /> TYPE OF PERMIT(S): Check appropriate box/boxes <br /> �5 <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling LlFilling/Grading 13Commercial Building Fee Rec: <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 � <br /> ❑ Boathouse ❑ Screen porch—campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway a) <br /> Proposed Structure/Addition Use: ZT A-P f4 C,r 6- W11'4 /2 A 4-r i Jnl/(/fid P+- N Z <br /> (Home/Cabin;Commerci <br /> iaal Business;Bedroom;Deck;etc.) <br /> Building Contractor: U� C.C UT C n A1Y'T/?0L7-%t/)Laster Plumber: Z Cry <br /> 0 <br /> Anticipated Start Date: /Z ��� +n C rn <br /> Pagel of 4 I <br /> Burnett County, WI Land Use Application—Rev 3/2016 <br />