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LAND USE PERMIT APPLICATION -Burnett County WI c <br /> b <br /> V �1 <br /> Permit Fees: o' <br /> a I <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 17 <br /> d <br /> Dwellin rinci al Building-Multi-Famil $300 Addition to DwellingfPrincipal Building-Multi-Famil $200 � <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) O <br /> Addition to Acc.Structure <br /> $150 Bunkhouse $250 1 <br /> Accessory Structure-Commercial(Cl &Ill $200 Addition to Accessory Structure-Commercial CI &Ii $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& o ` <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(l v $350 <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 Boathouse $500 <br /> 5 <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,landscaping,etc. r � <br /> 0 <br /> Applicant <br /> Complete All Sections Below This Line o <br /> Applicant's Name: r\ e—r\ <br /> ln /V��J e—yl� _ 1 \W r 1 \ • r �p <br /> Applicant's Mailing Address: 2,(9L46 LDuvv`y�O�.d eOS,etryV i <br /> City State zip o <br /> 2. z <br /> Applicant's Telephone Number: 2-342 <br /> o t <br /> 1 d <br /> Applicant's Email: Cu-I�v� W�v��e Q) Q (Y��t Co <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N av <br /> [-]Letter Phone ❑Email 1 <br /> w <br /> Legal Description: o <br /> 3. �} <br /> Lot#: CSM Vol. Pg. OR 0 <br /> Lot#: Block#: Subdivision Name: OR o <br /> 1 F <br /> Gov't Lot#: OR 1/4 1/4 <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 tax system property page. <br /> Parcel#(24 digits): <br /> � z <br /> Tax ID#(1-5 digits): <br /> X <br /> Property Site Address: SC�t^2 <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:-1co <br /> ❑ Single Family Dwelling Ll Multi-Family Dwelling ElFilling/Grading L3 Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs 4 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 <br /> Proposed Structure/Addition Use: Z o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) O 171 i <br /> Building Contractor: r C_\V//e��*+tSJLA s �ef'S L/L� Master Plumber: Z � en �_ <br /> Anticipated Start Date: c' - Z4 �.©Ile G) Q T <br /> Page 1 of 4 Z f <br /> Burnett County,WI Land Use Application—Rev 3/2016 :� �[� <br />