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LAND USE PERMIT APPLICATION — Burnett County, W[ r <br /> � C <br /> a ro <br /> . y N <br /> Permit Fees: <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 1 G <br /> Dwellin rind al Building-Multi-Family $300 Addition to Dwellin Princi al Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> O <br /> Accessory Structure(Non-Bunkhouse) \ E <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &II $200 Addition to Accessory Structure-Commercial CI &Il) $200 <br /> Deck/Stairs/Patio/Retaining Wail/Sidewalk/Driveway& <br /> Screen orches-in campgrounds only) ® Gazebo WI Stat 59.692(l v) $350 <br /> 17- <br /> Camping <br /> Cam in Unit $100 Filling/Grading $150 °^ r <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. b <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. <br /> Applicant Complete All <br /> Sections Below This Line o <br /> Applicant's Name: �! Z me &7,0 <br /> Applicant's Mailing Address: 027 3 Z g GLcS f r✓2U��S �r l4 /��I Cn o <br /> ZI/C6 5 fex-r (,/ Z SY8`'t 3 City State Zip c d <br /> o y <br /> Applicant's Telephone Number: f, v0 — 5-3 n —23 1 3� a <br /> d <br /> Applicant's Email: �� !`Lo / /®'_ 4,pjj y Ieck <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ,27?�5 E ,_4414Xd. ❑Letter [ Phone ❑Email <br /> Legal Description: Lv j l G SM V I io 17 1 /9 <br /> m <br /> Lot#: CSM Vol._ 9. ( 1 OR (1J <br /> Lot#: Block#: Subdivision Name: OR f,� <br /> Gov't Lot#: 7— OR 1/4 1/4 <br /> G <br /> Section#: 3 q 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 /> Property Site Address: <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes 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 ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition c <br /> ❑ Boathouse ❑ Screen porch—campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway M <br /> i f Ift.14 ce PV Z C <br /> Proposed Structure/Addition Use: 32 "a. i" f, 0tG ��><s St � rsf 0 -mi ^ <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: Master Plumber: .n Q <br /> Anticipated Start Date: /02 3�lp Z J <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />