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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Permit Fees: 0Ir 71 <br /> a <br /> DwellingfPrincipal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal 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 1 <br /> Accessory Structure-Commercial Cl&Il $200 Addition to Accessory Structure-Commercial Cl &Il $200 <br /> 0 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& � 1 <br /> Screenporches-in campgrounds only) $125 Gazebo WI Stat 59.692 lv $350 r <br /> Camping Unit $100 Fillin Gradin $150 °^ <br /> Permit Extension Valid for one year-Only 1 Allowed $100 Boathouse $500 rn <br /> 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 form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landsca in ,etc. <br /> ApplicantCompleteAll Sections Below This Line o <br /> Applicant's Name: M. t- 9 \ e LAX <br /> 1 f, rn� 5A t N <br /> Applicant's Mailing Address: � �� � ��h \ .� , `e Oa.O�V� � � b <br /> City State Zip w <br /> o <br /> Applicant's Telephone Number: ZL l <br /> � o <br /> Applicant's Email: 21 <br /> 1 <br /> o SO <br /> If staff has a question about this application how do y prefer to be contacted? Check one below. N <br /> 7 ❑Letter -]Phone f gEmail <br /> Legal Description: Yl <br /> Lot#: �CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: 0 43) <br /> Gov't Lot#: OR 1/4 1/4 p , <br /> Section#: Town#: N Range#: W Town of: r <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* g <br /> Parcel#(24 digits): 01 — 0 l <br /> *)L, `k Q rj ' D rj (s.. ` �LA " Q)St wo J <br /> Tax ID#(1-5 digits): 1 �' <br /> Property Site Address: 53 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes s J <br /> Fee Rec: � <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs R Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(Sv) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> ❑ Boathouse ❑ Screen porch—campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway —� <br /> Proposed Structure/Addition Use: ►k GrPC M <br /> (Nome/Cabin;Commercial Business;Bedroom;Deck;etc.) NZ Z <br /> ` m <br /> Building Contractor: \�2 b Master Plumber: Z bo <br /> 20 <br /> Anticipated Start Date: / G) 0 0 <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />