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LAND USE PERMIT APPLICATION — Burnett County,WI 0. (J) . <br /> b <br /> 4.. 11 k w H <br /> 7 r <br /> Permit Fees: ° <br /> Dwelling/Principal Building-Single Family $300 Addition to DwellingfPrincipal Buildin -Sin le Famil $200 <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwelling/Principal Buildin -Multi-Famil $200 �o <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Buildin $200 VAO <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse $250 I R <br /> Accessory Structure-Commercial CI &Il) $200 Addition to Accessory Structure-Commercial Cl &Il $200 <br /> v \ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& �. <br /> Screen orches-in campgrounds only) $125 Gazebo(WI Stat 59.692(l v $350 S <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 Boathouse $500 iv <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. 1 �— <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. 3 <br /> Appli Complete All Sections Below This Line a <br /> Applicant's Name: <br /> Applicant's Mailing Address: Gftll -(?eV,— 1?` <br /> v <br /> City State zip <br /> Applicant's Telephone Number: 320 U� n. <br /> \\^^� ` 'ry 1 d <br /> Applicant's Email. ��! �Yl n V VVrY-[A i <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N 00 <br /> ❑Letter .OPfione ❑Email 1 <br /> Legal Description: Se 4 <br /> h <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR50 <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: <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 /> � z <br /> Tax ID#(1-5 digits): y <br /> Property Site Address: <br /> s <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 a 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: 5-�� c 5�.��.1 <br /> (Home/Cab • ommercial Business:Bedroom,Deck;etc.) m <br /> L W <br /> Building Contractor: jZ1 l Master Plumber: K) I & o � <br /> T :7N <br /> Anticipated Start Date:�� Z � <br /> Page I of 4 <br /> Burnett County, WI Land Use Application—Rev 3/2016 <br />