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LAND USE PERMIT APPLICATION — Burnett County NVI a b <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family ° <br /> $300 Addition to Dwelling/Principal Princi al Buildin -Sin le Family $200 � G <br /> Dwell in rinci al 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) <br /> Addition to Acc.Structure $150 Bunkhouse $250 1 Pn <br /> Accessory Structure-Commercial CI &II $200 Addition to Accessory Structure-Commercial Cl &Il $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& 0 1 <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(l v) $350 <br /> Camping Unit $100 Filling/Grading <br /> $150 <br /> Permit Extension Valid for one year.-Only 1 Allowed $100 Boathouse $500 w <br /> m <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. d' <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. � <br /> Applicant Complete All Sections Below This Line o <br /> -_a.= <br /> Applicant's Name: / n U= y`nr c i- un) �cry Ue r►nr•" <br /> Applicant's Mailing Address: y� Ci—1 64 acr Circ I L F•,/15 5z) , S7108 <br /> City State zip <br /> Applicant's Telephone Number: ° o t <br /> Applicant's Email: t r V d.,p&N Vc, . C Or :: <br /> I <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> cj ❑Letter [gPhone ❑Email <br /> 71 <br /> Legal Description: P61�_I // <br /> drp � (-,.? �_1 <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR l l <br /> Gov't Lot#: OR 1/4 1/4✓ <br /> Section#: Town#: t% N Range# � <br /> 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): D <br /> Tax ID#(1-5 digits): <br /> N <br /> Property Site Address: 368 6 �� t s u /q ^a <br /> TYPE OF PERMIT(S): Check appropriate box/boxes s <br /> Fee <br /> SS 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 W <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition C <br /> m13 Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway Z cn ® u u <br /> m <br /> 140 <br /> Proposed Structure/Addition Use: l+c4 bo <br /> a <br /> {� ee ++ (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) (') <br /> Building Contractor: /J rat /he PJf.., Master Plumber: —��o C o <br /> r— <br /> CT) <br /> Anticipated Start Date: ZQ- ID—/L �°/ : �• <br /> 1` _ L I bo^t 14 ►22 Page 1 of 4 �J <br /> "er, uvl 's-y 87 2- Burnett County,WI Land Use Application-Rev 3/2016 <br /> 1� Scat- --217h <br />