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LAND USE PERMIT APPLICATION—Burnett County, WI a _ b <br /> m N <br /> Permit Fees: <br /> 6 <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 C7 <br /> Dwellin ci al Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> CommercialAndustrial Building $300 Addition to Commercial/Industrial Building $200 O <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Ace.Structure $150 Bunkhouse $250 1 <br /> Accessory Structure-Commercial Cl&Il $200 Addition to Accessory Structure Commercial Cl&Il $200 <br /> G1 <br /> Deck/Stairs/Patio/Retammg Wall/Sidewalk/Driveway& <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692 lv $350 r <br /> Camping Unit $100 Fdlin Gradin $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. <br /> W <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,landscaping,etc. <br /> o '- <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: d tYt�G K <br /> Applicant's Mailing dress: D�f <br /> City State Zip <br /> _ o y <br /> �} <br /> Applicant's Telephone Number: e. <br /> /n �p d <br /> Applicant's Email: <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. ro <br /> ❑Letter ❑Phone 2fmail <br /> Legal Description: d <br /> Lot#: CSM Vol. Pg. OR 5. a <br /> Lot#: Block#: Subdivision Name: OR oI <br /> Gov't Lot#:- OR 1/4 1/4 1 <br /> Section#: _Town#:__o N Range#:tel W Town of y 1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR atta&Vl4ar system proper page. <br /> r I <br /> Parcel#(24 digits): ©` D�,P 0/4 A:w �r <br /> n Z <br /> Tax ID#(1-5 digits): !�PL/d0 ° <br /> Property Site Address: l J�f7f� <br /> a <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:TAO <br /> ❑ Single Family Dwelling ❑ Mufti-Family Dwelling ❑ Filling/Grading ❑Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑Stairs 9 Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(iv) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> ❑ Boathouse ❑ Screen porch—campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway w <br /> Proposed Structure/Addition Use: <br /> me(Cabin;Commercial Bus' ss;Bedroom;Deck;etc.) <br /> o0 Z <br /> Building Contractor: Master Phtrrtber. Z <br /> Anticipated Start Date: "Z lrZ"z;i Qe4) <br /> Page 1 of 4 3 <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />