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LAND USE PERMIT APPLICATION - Burnett County, WI a b <br /> Permit Fees: a ?� <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 �7, 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 S) Z> Q <br /> Accessory Structure(Non-Bunkhouse) P r E <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &II $200 Addition to Accessory Structure-Commercial CI &I1) $200 C) <br /> G] ) <br /> Deck/Stairs/Patio/Retaining WalUSidewalk/Driveway& ° <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692 1 v $350 r, <br /> Camping Unit $100 Fillin Gradin $150 °^ <br /> Permit Extension Valid for one year-Only I Allowed $100 Boathouse $500 d <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. a <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 /> � - <br /> Applicant's Name: <br /> Applicant� Complete All Sections Below This Line o <br /> ` �? ��r r(�At �/` <br /> Applicant's Mailing Addresssj S�c/� - ` �7 ���pS�` /"� `�� �/0 Y_1 b <br /> City State zip < <br /> o E <br /> Applicant's Telephone Number: �' -�ys- 2. <br /> U <br /> Applicant's Email: J T e /e e (ry' jt1 a t .C U M <br /> 00 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> tterP ne []Email <br /> Legal Description: 't('1l,/LTp—���'� ° I <br /> Lot#: <br /> CSM Vol. Pg. OR a <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 1 ° <br /> Section#: Town#: N Range#: W Town of: <br /> 1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): <br /> Property Site Address: IL4 140,o5kont- a ( 5O{ c <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:0,0 <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(iv) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway <br /> , <br /> Proposed Structure/Addition Use: CCfr/, yC�tt�/W"r �°� a�. L�* -- (ax cn <br /> me/Cabin;Commerc iBusiness;Bedroom;Deck;etc.) N m <br /> O <br /> Building Contractor: Master Plumber: A1% Z <br /> Z r� <br /> Anticipated Start Date: <br /> Pagel of 4 a' �h- <br /> Burnett County,WI Land Use Application—Rev 3/2016 r----� <br />