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LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> a � C <br /> w r <br /> Permit Fees: <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwellin /Princi 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 Commercial/Industrial Building $200 (� <br /> Accessory Structure(Non-Bunkhouse) v t <br /> Addition to Ace.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(Cl &11 $200 Addition to Accessory Structure-Commercial C I &11 $200 1_ <br /> Deck/Stairs/Patio/Retaining WaU/Sidewalk/Driveway& ? — <br /> (Screenporches-in campgrounds only) $125 Gazebo(WI Stat 59.692(1 v)) $350 <br /> Camping Unit $100 Filling/Grading $150 —� <br /> Permit Extension(Valid for one year-Only 1 Allowed $100 Boathouse $500 < C <br /> w <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. w <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. r <br /> o – <br /> Applicant Complete All Sections Below This Line o 1 <br /> Applicant's Name: ��l'/ f j� 'L T P L<-f C- . <br /> Applicant's Mailing Address: /,e2� S 30-;iq 57"'SO ,j1-r6N /YIN SSoO t <br /> City State Zip <br /> Ch�L: <br /> Applicant's Telephone Number: b/� o. I <br /> Applicant's Email: (2 ; C )s i C k 6 y C{I'r 4-41 e0 r77 2 <br /> i <br /> v <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. JA <br /> N 00 t <br /> 0 <br /> ❑Letter Phone ,mail ' <br /> Legal Description: o <br /> Lot#: CSM Vol. Pg. OR � <br /> Lot#: Block#: Subdivision NarrA: OR o t <br /> Gov't Lot#: OR <br /> i L � <br /> Section#: �j Town R e ' W Town of: °t <br /> *Attach additional page if nee ed lengtl e ption OR attach a copy of the deed OR attach tax system property page.* <br /> J <br /> (( <br /> r I <br /> Parcel#,(24 digits): C97- 0/Z-2-'10–/5;-- 3S-3'— <br /> Tax ID#(1-5 digits): <br /> Property Site Address: 4 C--)re-Pr , E)&,L, W c G r U� <br /> TYPE OF PERMIT(S): Check appropriate box/boxes 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 Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(iv) ❑ Camping Unit ❑ Commercial Acc. Addition <br /> ❑ Boathouse ❑ Screen porch-campgrounds only Ll Retaining Wall ElSidewalk/Driveway C <br /> 6 <br /> Proposed Structure/Addition Use: 4)u6SE / S7-aIZJo66 ON 'TZ! <br /> /j�JQGrL /3 B 9 R NST/I V Cs/Wo Cabin;Commercial Business;Bedroom;Deck;etc.) Z y <br /> Building Contractor: /01VR,0t.1/y Master Plumber: fZ 0 N <br /> y _ o <br /> Anticipated Start Date: Z o-� <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />