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LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> Permit Fees: <br /> c <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-SiIF <br /> C <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Mw^ <br /> Commercial/Industrial Building $300 Addition to CommerciaUindustrial Building <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse 1 <br /> AccessoryStructure-Commercial Cl &11) $200 Addition to AccessoryStructure-Commercia1 ❑ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& ? t 10 <br /> Screenporches-in campgrounds only) 1 $125 1 Gazebo WI Stat 59.692(l v)) $350 _r <br /> Camping Unit 1 $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed) 1 $100 Boathouse $500 w S <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 be treated as accessory structures,such as:pergolas,landscaping,etc. m <br /> o <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: J 6C' if" Cj <br /> Applicant's Mailing Address: 3 �bL gi V(4 W � llj:f a �� (�t��%7 <br /> 7c� I e <br /> City State zip <br /> o y q2 / C <br /> Applicant's Telephone Number: �/4 5 4 7j J a <br /> 0 <br /> w <br /> Applicant's Email: 1 <br /> So <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. OQ <br /> N "� <br /> 0 <br /> G ❑Letter Phone ❑Email <br /> Legal Description: Z;, ��� �( �s� d t <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR f 1 <br /> Gov't Lot#: OR 1/4 1/4 D-- nQ AA <br /> Section#: 16 Town#: N Range#:� W Town of: <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): O y-DOD p///Op — <br /> s'O <br /> Tax ID#(1-5 digits): <br /> Property Site Address: N• 14 71 <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes <br /> Fee Rec: <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 <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(Sv) ❑ Camping Unit ❑ Commercial Acc.Addition ca <br /> ❑ Boathouse ❑ Screen porch—campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway C <br /> M co FH <br /> Proposed Structure/Addition Use: a�Jµ Q 4� A"V74V1') �4 <br /> (Hom abin:Commercial Business:Bedroom:Deck:etc.) 0t-+ <br /> I^ <br /> Building Contractor: C l� Master Plumber: E n <br /> o N <br /> O <br /> Anticipated Start Date: 1 C C-7)Page of 4 <br /> Burnett County,WI Land Use Application—Rev 31LU16 <br />