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LAND USE PERMIT APPLICATION — Burnett County WI a <br /> F+ <br /> Permit Fees: ;• � o� <br /> DwellingfPrincipal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le 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 v O <br /> Accessory Structure(Non-Bunkhouse) 1 E <br /> Addition to Acc.Structure $150 Bunkhouse $250 \ 9 <br /> Accessory Structure-Commercial Cl &11) $200 1 Addition to Accessory Structure-Commercial Cl &11) $200 e t <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(l v)) $350 r <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Permit Extension Valid for one year-Only 1 Allowed $100 Boathouse $500 w 111 1 <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. ro <br /> */terns not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. <br /> Applicant Complete All Sections Below This Line z <br /> Applicant's Name: /(u 6 JZ9,,¢e-A l <br /> Applicant's Mailing Address: cvs�b 81 41mvd 6,40 b <br /> City State zip o <br /> Applicant's Telephone Number: 13/7 34 6 44,5�9,0 a <br /> 0 <br /> Applicant's EmailiN&161 1.7B t <br /> ^o v <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N 00 t <br /> 0 <br /> ❑LetterPhone ❑Email ff <br /> Legal Description: SR- e Q qC hec <br /> N <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town o£ <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): b <br /> Tax ID#(1-5 digits): w �' <br /> Property Site Address: <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 )d Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition 100 0 <br /> ❑ Boathouse ❑ Screen porch—campgrounds only ❑ Retaining Wall ❑ Si dewalk/Driveway C <br /> Proposed Structure/Addition Use: G 9 / J eZ M r ^ <br /> (Nome/Cabin;Commerci Business;Bedroom;Deck;etc.) A CJS L UU <br /> Building Contractor: 4 F( CLeA21/ G OV. aster Plumber: �2 <br /> O N V <br /> O <br /> Anticipated Start Date: O8 O I 16 Z rn �U <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />