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LAND USE PERMIT APPLICATION - Burnett County, WI _ <br /> a <br /> y ~ 1 <br /> Permit Fees: G <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 /> m <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 Cl &11) $200 Addition to A cessory Structure-Commercial Cl &Il $200 <br /> o ' <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& � <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(l v)) $350 <br /> t- <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Permit Extension Valid for one year-Only 1 Allowed $100 Boathouse $500 w <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 /> t <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 /> Applicant's Name: <br /> Applicant's Mailing Address: <br /> City State zip <br /> PP P � -q <br /> Applicant's s Tele hone Number: c,. J <br /> �p t7 � <br /> Applicant's Email: M 41 1 c� Ry�� /yl5 N - <br /> �i o <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. o � w <br /> ❑Letter [rrPhone ❑Email <br /> w <br /> Legal Description: r t <br /> Lot#:_�` CSM Vol. Pg. OR ' <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#:59N Range#:___I W Town of: <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits): 0-141-"t�-3r'! /41-/D-6 C) <br /> n z , <br /> Tax ID#(1-5 digits): j :2,6 7 <br /> Property Site Address: 21CIP/b 191 fj(?A) k� �t2bry2a U/ �70�f <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:,�macn <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> A Single Family Addition ❑ Multi-Family Addition ❑ 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 00 �1 <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway C <br /> Proposed Structure/Addition Use:�nryl �'�tc7y� z <br /> (Home/Cabin;Commercial Business;Bedroom;Deck.,etc.) r.. <br /> ''!/ Cho <br /> Building Contractor:A,»1d/pJ_ Master Plumber: r , <br /> 0 <br /> Anticipated Start Date: - np _0QUL Z CT) <br /> Page 1 U 4 <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />