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LAND USE PERMIT APPLICATION - Burnett County, WI a �_ <br /> rn' <br /> Permit Fees: ? <br /> o <br /> DwellingfPrincipal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwellin Princi al Building-Multi-Famil $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) f <br /> Addition to Acc.Structure $150 Bunkhouse $250 1 <br /> Accessory Structure-Commercial Cl &Il $200 Addition to Accessory Structure-Commercial CI &Il) $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& ° 1 <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(l v)) $350 C <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 Boathouse $500 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. w' <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. 2 — <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. <br /> o <br /> ll 1 hApplicant Complete All Sections Below This Line 0 <br /> �t1 !1` - <br /> ID <br /> Applicant's Name: 011► � [�, Q,� �r'A-gin p® <br /> Applicant's Mailing Address: `3 9 0- / 0.2 rL b tl s4dxn 3 • - z <br /> City State Zip <br /> Applicant's Telephone Number: (-71S) 966 yJ~ c <br /> 1 y L d <br /> Applicant's Email: �C1 f`Is 1 (d f))�� �'r•�L( tfy T i✓r�P,� <br /> a <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> ❑Letter [tr 'hone ❑Email 7 <br /> Legal Description: o <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR 70o <br /> f <br /> Gov't Lot#: OR 1/4 1/4 1 <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 tar system property page. <br /> Parcel#(24 digits): -(� (j ' y0 )6 ' N's ��UDSk5L ocno <br /> z w <br /> Tax ID#(1-5 digits): '. `f 1 y X <br /> Property Site Address: <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:�` e <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ 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 � <br /> ❑ Boathouse ❑ Screen porch—campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway I" <br /> Proposed Structure/Addition Use: (7 a 00L6 P Ji h Q le) m <br /> (Ho elCabin;Commer�ct Business;Bedroom:Deck;etc.) o <br /> �-te / ZBuilding Contractor: o <br /> Z 0 <br /> Anticipated Start Date: +6 0 0 <br /> Page 1 of 4 Z cn <br /> Burnett County,WI Land Use Application —Rev 3/2016 <br />