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LAND USE PERMIT APPLICATION— Burnett County. WI a <br /> Permit Fees: <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwellin rinci al Building-Single Family $200 <br /> Dwellin Principal 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 /> Accessory Structure(Non-Bunkhouse) l £O <br /> Addition to Acc.Structure $250 'm <br /> $150 Bunkhouse <br /> Accessory Structure-Commercial Cl &II) $200 Addition to Accessory Structure-Commercial Cl &II) $200 a <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& <br /> Screenporches-in campgrounds only) $125 Gazebo WI Stat 59.692(l v $350 r <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Permit Extension Valid for one ear-Only1 Allowed $100 Boathouse $500 w <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. ti <br /> *ltems not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. <br /> / <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: �IC haee ( A\. }v b ✓ <br /> Applicant's Mailing Address: 1-1 U 3 Iv- VAJkgn Ut �C� )I rte CyZ 54G1Z ro <br /> City State zip <br /> o � <br /> Applicant's Telephone Number: <br /> Applicant's Email: o,&A i-k o <br /> t <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> ❑Letter IXPhone [-]Email ° 1 <br /> Legal Description:W 3 CSI^'\ V Iq PIII 'F1&l.4 CSS T 46 PGS I3 £- Z - fou Loi l o <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 I ° <br /> Section#: Town#: N Range#: W Town of: IIy 1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* W <br /> Parcel#(24 digits): <br /> � z <br /> Tax ID#(1-5 digits): C <br /> Property Site Address: � u u kew, La- Vi- <br /> Vr , (.V= <br /> c <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:ia <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition 1(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-camp—grounds only ❑ Retaining11 Wall E3Sidewalk/Driveway C <br /> i <br /> Proposed Structure/Addition Use: ,/— 4-t��) S Vt k r 5 Z � <br /> (Home/Cabin;Commercial Busine s;Bedroom;Deck;etc.) M <br /> Building Contractor: M�1Gu� �yu�C� Master Plumber: �►� Z <br /> Z 0 <br /> Anticipated Start Date: G)QC o <br /> Page 1 of 4 Z �j aj <br /> Burnett County, WI Land Use Application—Rev 3/2016 cs <br />