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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> a <br /> m <br /> Permit Fees: 5 c <br /> a <br /> Dwelling/Principal 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 /> CommerciaVlndustrial 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 CI &11) $200 Addition to Accessory Structure-Commercial Cl &Il $200 <br /> 0 <br /> Deck/Stairs/Pa6o/Retaining Wall/Sidewalk/Driveway& < <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(Iv)) $350 <br /> r <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Permit Extension Valid for one year-Only 1 Allowed $100 Boathouse $500 y <br /> d <br /> 0 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. �v <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Applicant Complete All Sections Below This Line o <br /> J <br /> Applicant's Name: A!n L"; I�AA R I So N <br /> 75 /9 <br /> 7 / n <br /> Applicant's Mailing Address: S /9 oybSt / 6 l• � I i/d/U�UR`� /N/ 7K <br /> / <br /> City State zip y # <br /> Applicant's Telephone Number: 612 J?9`UQ�F7 o <br /> s� �7 <br /> Applicant's Email: ( CO YRn�ry �a� Ir� 'r'n-- <br /> �T <br /> b <br /> If staff has a question about this application how do you prefer tobee enacted? Check one below. N tl0 <br /> [:]Letter ❑Ph a (_QEmail <br /> Legal Description: <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR f <br /> Gov't Lot#: OR 1/4 1/4 I ' <br /> Section#: Town#: N Range#: W Town of: <br /> 01 1 <br /> I <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits): <br /> n z <br /> Tax ID#(1-5 digits): / // / y �' <br /> Property Site Address:'S Ig ft?,e, Dtu 6t`t'1 �7/ l <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> 2u <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition E3 ulti-Family Addition LlDeck/Patio ❑ Commercial Addition <br /> L] Stairs Y ACC. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(1v) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> ❑ Boathouse ❑ Screen porch—campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway <br /> Proposed Structure/Addition Use: PGlt -6$t ('n =1 o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) M C-) <br /> 0f15 <br /> Building Contractor: Se Master Plumber: Z <br /> Anticipated Start Date: /J G)j 0 <br /> �T Page 1 of 4 Z T �U <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />