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LAND USE PERMIT APPLICATION- Burnett County, WI a b <br /> y <br /> H �1, <br /> Permit Fees: <br /> DwellingTrincipal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaUtndustrial Building $200 a <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse $250 i <br /> Accessory Structure-Commercial(Cl &II) $200 Addition to Accessory Structure-Commercial(CI &11) $200 <br /> C) <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& ° 1 <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(l v)) $350 <br /> Camping Unit $100 Filling/Grading $150 QJ °^ <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 Boathouse $500 U' <br /> m <br /> 0 <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 /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> / lApplicant Complete All Sections Below This Line o <br /> Applicant's Name: tn. KC t J <br /> Applicant's Mailing Address: Zy,6r,/ a ZKC o <br /> 10 <br /> City State Zip <br /> O y <br /> �/.,/ <br /> Applicant's Telephone Number: 7/�`-S / /v2 <br /> / d <br /> Applicant's Email: dec., . /'cfd Z C 6�nll <br /> d - i r / G.[ <br /> 'v <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. c w <br /> ❑LetterPhone Email <br /> Legal Description: <br /> o t <br /> Lot#: CSM Vol. Pg. OR o, <br /> Lot#: Block#: Subdivision Name: S W i 3S V. OR k 1 <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: y 1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* j" <br /> N <br /> Parcel#(24 digits): <br /> z <br /> Tax ID#(1-5 digits): 7' <br /> Property Site Address: Z9 7b5' rrl,ncrvr. C41`414 <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: Iso <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs 16 Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition W <br /> ❑ Boathouse ❑ Screen porch—campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway C <br /> :0 i <br /> Proposed Structure/Addition Use: (� N m <br /> pp (Ho / a in;Commercial Business;Bedroom;Deck;etc.) O CSO 11-t� <br /> Building Contractor: SG�r Master Plumber: AlAr Z v <br /> 0 <br /> Anticipated Start Date: "1 " I - l( Z <br /> Page 1 of 4 <br /> Burnett County, WI Land Use Application—Rev 3/2016 �� <br />