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LAND USE PERMIT APPLICATION —Burnett County WI ro r <br /> K N <br /> Permit Fees: o" <br /> N <br /> Dwellin rinci al 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 Structure(Non-Bunkhouse) O <br /> Addition to Acc.Structure $250 ) <br /> $150 Bunkhouse <br /> Accessory Structure-Commercial C1 &11) $200 Addition to Accessory Structure-Commercial C1 &11) $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& d<n <br /> Screen orches-in campgrounds only) $125 Gazebo(WI Stat 59.692(Iv)) $350 C <br /> Camping Unit $100 Filling/Grading Filling/Grading $150 ° <br /> Permit Extension Valid for one year-Only I Allowed $100 1 Boathouse $500 <br /> a <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. <br /> rn <br /> *items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. � <br /> 0 <br /> Applicant Complete All Sections Below This Line c <br /> Applicant's Name: } '�(�G/>C fly 1!t/0 / / <br /> Applicant's Mailing Address: Fi /Z I f7U�'�/vn Jed )ICJ, �Gl.�7Z ro <br /> City State zip # <br /> 2. <br /> Applicant's Telephone Number: 21S LIJ9 022,0, c J <br /> 0 <br /> Applicant's Email: �D Wd GGi1 ���f�eA A;f 17e- <br /> If <br /> 7eIf staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter ®Phone ❑Email 7jcf 22 z -�l1 f✓� T� �� 1 <br /> Legal Description: <br /> Lot#: CSM Vol. Pg. OR <br /> m <br /> Lot#: Block#: Subdivision Name: OR L o <br /> Gov't Lot#: OR 1/4 1/4 1 <br /> Section#: Town#:? _N Range#:—[.�—W Town of. I b '� <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):-01YA-39 I S M-5-051 mis( a0cp t <br /> z <br /> Tax ID#(1-5 digits): 0 qp, <br /> Property Site Address: ?l y713 , k 6 � <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes <br /> Fee Rec:-30��/•oc) <br /> X Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition A'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 13 Retaining Wall L3Sidewalk/Driveway C <br /> Proposed Structure/Addition Use: rTl)me Z D �U <br /> _ N <br /> �] (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) / Q � <br /> Building Contractor: J� 7 "1 r7LDWe- 64AO Iastei Plumber: �f/�,�ru25- A0 F,6)�y-, /-47� Go <br /> Anticipated Start Date: <br /> Page 1 of 4 <br /> Z <br /> Burnett County, WI Land Use Application—Rev 3/2016 4 <br />