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LAND USE PERMIT APPLICATION — Burnett County, WI b <br /> a <br /> a -_ <br /> b <br /> y � � <br /> Permit Fees: `r <br /> � J o. 0N <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <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 <br /> Accessory Strucmre(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse $250 1 <br /> Accessory Structure-Commercial C l&11) $200 Addition to Accessory Structure-Commercial(C 1 &11) <br /> $200 <br /> Deck/Stairs/Patio/Retaining WalUSidewalk/Driveway& ? 1 <br /> (Screenporches-in campgrounds only) $125 Gazebo(Wl Stat 59.692(ly)) $350 <br /> r <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension afid for one year-Only 1 Allowed) $100 Boathouse $500 m <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. 2. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. 2 <br /> -e <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r <br /> 0 <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: �� <br /> Applicant's Mailing Address: ZtF--�2.4& <br /> City State Zip C <br /> Applicant's Telephone Number: A 1y)`-7 z, <br /> n o775 <br /> Applicant's Email: ��il'V /A <br /> o I <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N 00 <br /> Letter ❑Phone Email I � <br /> Legal Description: `ty d Al <br /> r <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 -�� <br /> Section#: '30 Town#:_1-7_N Range#: 19 W Town of: 1/ <br /> *Attach additional page ijneeded jor lengthy description OR attach a copy of the deed OR attach tax system property page.* — <br /> Parcel#(24 digits): U — 2;-9 <br /> n z <br /> Tax ID#(1-5 digits): oZ`4 1 F/ H <br /> SYS <br /> Property Site Address: l2ci vtQ� Line IZ _ ��l�.q 75>�� �� t t'l <br /> ?-,0Sr7� <br /> tc <br /> TYPE OF PERMIT(S): Check appropriate box/boxes iate b /ba t' <br /> Fee Rec: L <br /> fSingle Family Dwelling L1 Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> /❑ Single Family Addition ❑ Multi-Family Addition 16 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 C F-�— <br /> Proposed Structure/Addition Use: �bf21{� rrrt <br /> (Holme/Cabin;Commercial Business;Bedroom;Deck;etc.) L N rn <br /> Building Contractor: /�j/-) �r/1�L� Master Plumber: d �2wt t C lk+ei - Z B <br /> 20 <br /> Anticipated Start Date: +17 C rn <br /> Page 1 of 4 Z <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />