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LAND USE PERMIT APPLICATION- Burnett County, WI a _ <br /> ta' <br /> Permit Fees: <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 d .7I _� <br /> Dwellin rinci al Building-Multi-Famil $300 Addition to Dwelling/Principal Building-Multi-Famil $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial CI &11) $200 Addition to Accessory Structure-Commercial(Cl &Il $200 <br /> Deck/Stairs/Pado/Retaining Wall/Sidewalk/Driveway& <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(1 v) $350 r <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Permit Extension Valid for one year-Only 1 Allowed $100 Boathouse $500 m <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. w' <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. 1 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> ApplicantCompleteAll Sections Below This Line o <br /> Applicant's Name: v'�1 +���(c�ni, <br /> Applicant's Mailing Address: `� r`�D (J 45 (Crh•ll ��, (n�Ce��yy U/1 .5— � L ro <br /> City °T State zip <br /> o � <br /> Applicant's Telephone Number: Z40 o' a <br /> Applicant's Email: TL/c�yo�,N6�(V C? <br /> ro <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> ❑Letter ❑Phone Wrmail <br /> o� <br /> Legal Description: R <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR o <br /> Gov't Lot#: OR 1/4 1/4 5 I ` <br /> Section#: Town#: N Range#: W of. y <br /> *Attach additionalpage if needed far lengthy description OR attach a copy of the deed OR attach tax system property page.* X <br /> Parcel#(24 digits): <br /> n z <br /> Tax ID#(1-5 digits): <br /> Property Site Address: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: �t/o <br /> LISingle Family Dwelling ❑ Multi-Family Dwelling LIFilling/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 ❑ Screen porch—caampgrounds only 13Retaining Wall L3Sidewalk/Driveway C <br /> Proposed Structure/Addition Use: t`o`/ yd <br /> C( /,? c' - Z C <br /> / (Home/Cabin;Commercial Business,,Bedroom;Deck;etc.) / O M z <br /> Building Contractor: V ef{ A/Cfi'0, Master Plumber: �( � Z <br /> o Z 0 ^' <br /> Anticipated Start Date: ` e�` 2�/� Q O o <br /> C <br /> Page 1 of 4 Z Uf l <br /> Burnett County,WI Land Use Application—Rev 3/2016 4 <br />