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LAND USE PERMIT APPLICATION-Burnett County. WI a <br /> a <br /> y N. <br /> Permit Fees: a e, <br /> 0. <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwellin ci al Building-Sin a Family 5200 <br /> Dwelling/Principal Building-Multi-Farmly 5300 Addition to Dwellin ci al Building-Multi-Farm] $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Sbucture(Non-Bunkhouse) <br /> Addition to Ace.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Connnercial C]&Il $200 Addition to Accessory Structure-Commercial CI&Il $200 I <br /> Deck/StairwPatio/Retaming Wall/SidewaUdDriveway& ° Il <br /> Screen rhes-in campgrounds only) $125 Gazebo WI Stat 59.692 lv $350 S, <br /> Campmg Unit S100 Filling/Grading Filling/Grading $150 <br /> Permit Extension(Valid for one year-Only 1 Allowed $100 Boathouse 5500 ti <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. d <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. A <br /> o ' <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: `�J )y 1�ti �f(�Qt'/ise-" ' ,, / c� <br /> Applicant's Mailing Address: L S I dJrl��SwfCV��< SG�yzui(L {19/l c��7 0 <br /> Cityj State Zip C a <br /> Applicant's Telephone Number: 1 < (J-) 262- —ZZ <br /> � a m <br /> Applicant's Email: SV t"-k y S 1 1 Vre q <br /> ro <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N0 SO <br /> 00 <br /> Letter OPhone ®Email <br /> Legal Description: d <br /> N <br /> Lot#: .3 CSM Vol. /0 P9.737-239 OR 3 <br /> m <br /> Lot#: Block#: Subdivision Name: OR o <br /> Gov't Lot#: 7 OR 1/4 1/4 <br /> Section#: jTown#: N Range#:�[ W Town of: c) 4 c ks p kl <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: !_y iz-3 F t'[1-7LGGr t, ! /`0a_c <br /> c <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> ❑Single Family Dwelling 13 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 �-�--� <br /> ❑ Boathouse ❑ Screenrjch-campgrounds only LlRetaining Wall ❑ Sidewalk/Driveway <br /> oposed Structure/Addition Use: t t I I Ioc, - ^ <br /> (Her re/Cabin:Commercial B W� s:Bedroom:Deck:etc.) Z m <br /> � tJ u U <br /> J ® m <br /> Building Contractor: Master Plumber: Z h" <br /> Anticipated Start Date: 04 X Cxt4 -,2� ® oN � <br /> Page 1 of 4 CC C7)Burnett County,WI Land Use Application-Rev 3/2016 � <br />