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LAND USE PERMIT APPLICATION — Burnett County X I q <br /> a <br /> Permit Fees: o' <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 G <br /> Dwelling/Principal Building-Multi-Family $300 Addition to DwellingfPrincipal Building-Multi-Family $200 <br /> m <br /> Commercial/Industrial Building $300 Addition to CommerciaUIndustrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) O <br /> Addition to Acc.Structure �E <br /> $150 Bunkhouse $250 m <br /> Accessory Structure-Commercial C1&Il $200 Addition to Accessory Structure-Commercial(CI & I1) $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& 0 1 <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692 lv) $350 r <br /> Camping Unit $100 Filling/Grading $150 ° �C <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. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. Q <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. <br /> rn <br /> o — <br /> (� Applicant Complete All Sections Below This Line c <br /> Applicant's Name: 1 I t Q-r I L 1 0_t'10l � CLC— <br /> Applicant's Mailing Address: �� � ►r� Rd- U ,(j mN w Ib <br /> City Sfate Zip < <br /> SSI - �� <br /> Applicant's Telephone Number: -3 ' 0(o �3 S $. -21 <br /> \ <br /> (l v <br /> Applicant's Email: Je GO m <br /> If staff has a question about this application how do y u prefer to be contacted? Check one below. N \ 1 <br /> []Letter hone ❑Email <br /> Legal Description: 22 �I o <br /> Lot#: CSM Vo13 1 a Pg.� OR <br /> Lot#: Block#: Subdivision Name: OR c <br /> Gov't Lot#: OR 1/4 1/ - <br /> Section#: Town#: N Range#: I T W Town of- us y <br /> *Attach additional page if neededfor lengthy descriptions ORattacha copy of the deed OR attach tax system property page.* lJ� <br /> Parcel#(24 digits): <br /> Z <br /> Tax ID#(1-5 digits): y �' <br /> Property Site Address: <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec.-450 <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 m <br /> Proposed Structure/Addition Use: dJ rc'rC r�`1�/ a <br /> (Home/Cabin;Commerci Business;Bedroo ck;etc.) rrl <br /> j1 <br /> Building Contractor.J! <br /> J Ot� <br /> ec <br /> Anticipated Start Date: -' �� N <br /> C <br /> Page 1 of 4 Z l�fl <br /> Burnett County, WI Land Use Application-Rev 3/2016 � (�� <br />