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LAND USE PERMIT APPLICATION — Burnett County WI & ro r <br /> a <br /> Permit Fees: `r <br /> `A <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwellin rind al Building-Single Family $200 � C7 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaVlndustrial Building $200 (— <br /> Accessory Structure(Non-Bunkhouse) t1 <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(Cl &II $200 1 Addition to Accessory Structure-Commercial(Cl &Il) $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(1 v)) $350 r <br /> Camping Unit $100 Filling/Grading $150 °^ <br /> Permit Extension Valid 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. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> ro <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. <br /> Applicant Complete All Sections Below This Line <br /> Applicant's Name:/[/J!/ �j Ve—/—C6'I��t7/'J <br /> Applicant's Mailing Address: 2�� V�g /`r���i�� '���iozw ro <br /> City State zip <br /> Applicant's Telephone Number: 601 Zw 6,97g-7 <br /> d <br /> Applicant's Email: <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> ❑Letter []Phone ❑Email <br /> 1 <br /> Legal Description: —.06e, �CCd4 1 d <br /> N <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR o <br /> jjF <br /> Gov't Lot#: OR 1/4 1/4 1 <br /> Section#: i Town#: -31 N Range#:-J-7--W Town o£ kj GO {� 11V, H _ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> Parcel#(24digits) —O/lp�Z�3�'/?-0/�� D3—000 �o/BODo x <br /> Tax ID#(1-5 digits): <br /> Property Site Address: f4�,e, <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec. .Vl/ <br /> L3 Single Family Dwelling ❑ Multi-Family Dwelling LlFilling/Grading E3 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 ® <br /> ❑ Boathouse ❑ Screen porch—campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway C <br /> '/ 03Proposed Structure/Addition Use: 9/"U�'O,5 e. Q c?,, O/� N Z z <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;;etc.) Z —I � <br /> Building Contractor: N:� Master Plumber: y`� Z 0 <br /> 17o N G <br /> Anticipated Start Dilate: Z <br /> Page 1 of 4 �J <br /> V" Burnett County,WI Land Use Application-Rev 3/2016 <br />