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LAND USE PERMIT APPLICATION - Burnett County, WI a (n ro <br /> y R 1 <br /> Permit Fees: e a <br /> n <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Family $200 � 0 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Farm] $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Stmcture(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse £ <br /> $250 <br /> Accessory Structure-Commercial(Cl &Il $200 Addition to Accessory Structure-Commercial Cl &Il) $200 <br /> 0 <br /> DecWStairs/Pallo/Retaining Wall/Sidewalk/Driveway& � <br /> Screen orches-in campgrounds on] ) 1 $125 1 Gazebo WI Stat 59.692 lv $350 S <br /> Camping Unit 1 $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. ' O <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping, etc. <br /> Appli�c /ant Complete All Sections Below This Line o <br /> Applicant's Name: <br /> Applicant's Mailing Address: ��� ��1/ Uk1t �r�n/S�'X/C� w��y15 yG W <br /> City U State 'Zip ,t <br /> Applicant's Telephone/ V Number: j c , <br /> Applicant's Email: ` � W& Ko 11ofn. 6—� � I i(/.�k- <br /> % <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> Letter ❑Phone ❑Email 'S t <br /> Legal Description: � �} a o <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR o <br /> 7C1 <br /> Gov't Lot#: OR 1/4 1/4 <br /> i <br /> Section#: Town#: N Range#: W Town of: a <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> r <br /> Parcel#(24 digits): <br /> � z <br /> Tax ID#(1-5 digits): <br /> Property Site Address:JI/ � rj {�j��/ �A A(� <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> ❑ Single Family Dwelling L3 Multi-Family Dwelling E3Filling/Grading Ll Commercial Building <br /> L3Single Family Addition Ll Multi-Family Addition L3Deck/Patio E3Commercial Addition <br /> L3Stairs LlAcc. Structure(Non-bunkhouse) ❑ Bunkhouse L3Commercial Acc. Structure � <br /> L3Permit Extension L3Gazebo–WI Stat 59.692(Sv) 13Camping Unit L3Commercial Acc. Addition <br /> L3Boathouse E3Screen porch–campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway =IZ m <br /> l m <br /> Proposed Structure/Addition Use: leo VI (/11►d.,e i— r� <br /> (Home/Cabin;Comjhercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Master Plumber: 0 !� <br /> 0 <br /> _ 1 // C: <br /> Anticipated Start Date: ` / V Z lJ u u <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />