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Permit Fees: o� <br /> a <br /> Duel' rind al Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le 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) <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial C1 &I1 $200 Addition to Accessory Structure-Commercial Cl &II $200 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> Screen orches-in campgrounds only) $125 Gazebo(WI Stat 59.692(]v)) $350 r <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Permit Extension(Valid for one year-Only I 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, d <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. o <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: <br /> Applicant's Mailing Address: 2-7 3__2 I ✓J5 L k e d OS S 3 b <br /> City State Zip < <br /> _ o <br /> Applicant's Telephone Number: 7f5 — 79 1 — DO® I r a <br /> 1"C�I C <br /> Applicant's Email: G r V Z(0)_ L701GLj Ji G O in <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N oo t <br /> 0 <br /> Letter 01 [SPhone ❑Email e 1 <br /> ao <br /> Legal Description: U. <br /> Lot#:_ CS Vol. Pg. _JF_/ OR <br /> Lot#: Block#: Subdivision Name: OR I o i <br /> Gov't Lot#:- OR 1/4 1/4 � <br /> Section#: 9 6� Town#:_,410 N Range#:__I W Town of: (fie <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): ) <br /> n z <br /> Tax ID#(1-5 digits): / y 0 G <br /> Property Site Address: oZQ <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 ;K.Deck/Patio ❑ Commercial Addition <br /> ❑Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> ❑ Boathouse ❑ Screen porch—campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway <br /> Proposed Structure/Addition Use: tom e_ 4/,:,tr L W <br /> (HomelCabia;Commercial Bw•(neaa•,-Bedroom;Deck;etc.) C <br /> / Z <br /> Building Contractor: ��,� t„v L�,....t Master Plumber: A.) /n, Z o rn <br /> Anticipated Start Date: �,l is O N v <br /> Page 1 of 4 z rn <br /> Burnett County, WI Land Use Application—Rev 3/2016 <br />