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i <br /> LAND USE PERMIT APPLICATION—Burnett CountyWI r <br /> a <br /> E2. <br /> _'ermit Fees: N� <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 C7 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwellin Princi al 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 I 'n <br /> Accessory Structure-Commercial(Cl &I1) 1 $200 Addition to Accessory Structure-Commercial CI &Il) 1 $200 1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(l v)) $350 5 <br /> Camping Unit $100 Fillip Gradin $150 <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 Boathouse $500 d <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 farm,see corresponding application and fees. <br /> ro <br /> */terns not listed above will be treated as accessory stnectures,such as:pergolas, landscaping,etc. t— � <br /> o — <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: Kth v 4- `7 <br /> Applicant's Mailing Address: ro <br /> City State Z• z <br /> Applicant's Telephone Number:_ / /V c n <br /> '�-,�i/arse r� <br /> Applicant's Email: ��- <br /> 7� 9 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N t <br /> ❑Letterhone ail// �n <br /> Legal Description: . ���d�Nl i 5 �� i d & U�/,/�� JU 4 3) o I <br /> Lot#:_0 CSM Vol. Pg. OR <br /> Lot#: ' Block#:_ Subdivision Name: IA( GV R <br /> Govt Lot#: OR 1/4 1/4 1 <br /> Section#: Town � N Range#:— �W Town of: IlWhIc JLy G <br /> 1 <br /> *Attach additional page if needed for lengthy description ORattacha copy of the deed OR attach tar system property page.* <br /> Parcel#(24 digits): <br /> Z <br /> Tax ID#(1-5 digits): 4 <br /> Property Site Address: <br /> s c <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:3 <br /> ❑ Single Family Dwelling Ll Multi-Family Dwelling 13Filling/Grading LI Commercial Building <br /> A Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs W 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 a) <br /> N\ nd�.�n <br /> Proposed Structure/Addition Use: ! �'����� �^c- O (�� �` �S �ifc X <br /> c <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) � O 171 v� <br /> _ : , <br /> Z <br /> Building Contractor: Master Plumber: �(lf <br /> Z 0 `a r� <br /> Anticipated Start Date: 00 o <br /> Page 1 of 4 Z (� <br /> Burnett County,WI Land Use Application—Rev 3/2016 rr=—� <br />