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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> y m y H <br /> Permit Fees: <br /> a <br /> Dwellin rinci al Building-Single Famfl $300 Addition to Dwellin Princi al Building-Single Family $200 <br /> Dwellin Princi al Building-Multi-Family $300 Addition to Dwellin Princi al Building-Multi-Family $200 ^, <br /> Commercial/Industrial Building $300 Addition to CommerciaVlndustrial Building $200 V O <br /> Accessory Structure(Non-Bunkhouse) `� £ <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial CI &11) $200 Addition to Accessory Structure-Commercial Cl &II) $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> Screenporches-in campgrounds only) $125 Gazebo WI Stat 59.692(l v)) $350 S S� <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 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 and fees. I (, <br /> */terns not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. <br /> Applicant Complete All Sections Below This Line o O <br /> Applicant's Name: ;e, 'v ft-<),O <br /> Applicant's Mailing Address: Q.O. �X 4�a lnfP [ec �fS• �`/df`I 3 <br /> City State zip c 0 <br /> / may,Q! r J <br /> Applicant's Telephone Number: b 4<1- - 542 r a t <br /> Applicant's Email: p <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N w <br /> ❑Letter [hone ❑Email ' t <br /> Legal Description: o G <br /> 1 <br /> Lot#: CSM Vol. Z3 Pg. -2-2 OR <br /> Lot#: Block#: Subdivision Name: OR W 8' <br /> V` � tN <br /> Gov't Lot#: OR ni 1/4�_t/4 \ V1 <br /> t <br /> Section#: .3,50 Town#: /6_N Range#:_ W Town of. to Q W <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system propertypage.* O � G <br /> Parcel#(24 digits): O 7`QaO -1 -4/O -16 -3S-3 - 01 - 000 - OI U00 p O <br /> Tax ID#(1-5 digits): <br /> Property Site Address: l40 7 (AL 800t.10 - /,aKt <br /> 0 <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes o0 <br /> /aS — <br /> ❑ Single Family Dwelling Ll ❑Multi-Family Dwelling Iling/Grading ❑ Commercial Building Fee Rec: <br /> ❑ Single Family Addition ❑ Multi-Family Addition UV 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 U Retaining Wall LlSidewalk/Driveway F r✓ rn <br /> Proposed Structtue/AdditionUse: m tp / SI�ewalk N p�q <br /> �1 (Ho`e/Cabin;Commercial Business:Bedroom;Deck;etc.) � �II <br /> Building Contractor:_I&JiE l Schoo/ rJE< Master Plumber: MA <br /> Anticipated Start Date: :7-.25-1 M <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />