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LAND USE PERMIT APPLICATION — Burnett County, WI c <br />Applicant Complete All Sections Below This Line <br />Permit Types and Fees: (Check appropriatehox/boxes) <br />Dwelling/Principal Building - Single Family $300 <br />Addition to Dwelling/Principal Building - Single Family <br />$200 <br />Dwelling/Principal Building - Multi -Family $300 <br />Structural Alteration to Dwelling/Principal Buildings <br />$200 <br />Commercial/Industrial Building $300 <br />Addition to Commercial/Industrial Building <br />$200 <br />Accessory Structure(Non-Bunkhouse) $150 <br />Addition to Accessory Structure <br />$150 <br />Bunkhouse $250 <br />Structural Alteration to Accessory Structure <br />$150 <br />Accessory Structure -Commercial (C1 & I1) $200 <br />Addition to Accessory Structure -Commercial (C1 & I1) <br />$200 <br />Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway & <br />Campground Structures $125 <br />Gazebo (WI Stat 59.692(lv)) <br />Filling/Grading <br />$350 <br />$150 <br />Camping Unit (Six Months Per Year) $100 <br />Boathouse <br />$500 <br />Permit Extension (Valid for one year - Only 1 Allowed) $100 <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 andfees. <br />*Items not listed above will be treated as accessory structures, such as: pergolas, landscaping, etc. <br />Property Owner's Name: Lin ,ren , <br />Property Owner's Mailing Address: 'Da s <br />City State Zip <br />Property Site Address: / 1(v djk g' ,s P1 0-7-0d g ,,- <br />Contact's Telephone Number:([7jr�' S aS %� (&a,rtrADrt) <br />Contact's Email: bt'M k e- Cc t I = Corn <br />Legal Description of Property: CSM V& Po,;O 6aj-V L,4- 5`d(,) <br />Section #: Town #:LIO N Range #: W Town of .SCo,* <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br />Tax ID # (1-5 digit number; found on tax statement): <br />Proposed Use of Structure/A ditiop:;—��I.S�t/ C r /G„� Et7i5� cn Cc>rrlw/ <br />Anticipated Start Date:l,G �L /'��� (Home/Cabin; ommercial Business; Bedroom; Deck; etc.) <br />Building Contractor: ;y(,S �X« ,� d l-�w' C Sewer Installer: <br />THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED B OW: <br />Date of staff site visit: <br />PERMIT APPROVED <br />Initials of site visit staff: <br />OFFICIAL: DATE <br />MMAM <br />Page 1 of 3 <br />Burnett County, WI Land Use Application — Rev 03/2017 <br />n <br />h <br />Z 3 <br />t <br />O NO <br />_o <br />Z <br />4 n <br />