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R LAND USE PERMIT APPLICATION- Burnett County, WI <br /> CL 2 C71 <br /> Permit Fees: <br /> Dwellin rinci al Building-Single Family <br /> $300 Addition to Dwellin rinci al Building-Sin le Family $200 � C7 <br /> DwellinglPrincipal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 °^ <br /> m <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkho O <br /> Addition to Ace.S $150 Bunkhouse $250 1 <br /> Accessory Structure-Commercial Cl &11) $200 1 Addition to Accessory Structure-Commercial Cl &Il) $200 0 1 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& < <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692 lv) $350 r <br /> Camping Unit $100 Filling/Grading $150 o <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. z <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. � S— <br /> Applicant Complete All Sections Below This Line o ' <br /> Applicant's Name: Com+ ` (=A-- \%o C-- <br /> Applicant's <br /> Applicant's Mailing Address: Z 3-1 b ���s�ta. �hti ���-o-, 2 - Lit 5AY3 <br /> City State zip <br /> o � q <br /> Applicant's Telephone Number: 320 - 'A 61 <br /> o O <br /> Applicant's Email: tff W t�!_f,N vv, ©01 r j t. <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. t <br /> ❑Letter ❑Phone `A Email 9j <br /> a� <br /> Legal Description: t7 j <br /> F <br /> Lot#: CSM Vol. Pg. OR <br /> ti l <br /> Lot#: Block#: Subdivision Name: OR o ) <br /> 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): 150 t p <br /> Property Site Address: '2 q S71 \vY..S�c..��.. -� (Z� v i�uw� W ► S y 27 " I <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: I So <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs 1(Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition <br /> L3 Boathouse L3 Screen porch-campgrounds only L3 Retaining Wall ❑ Sidewalk/Driveway C <br /> M r_ M <br /> c <br /> Proposed Structure/Addition Use: � z <br /> (Home abin;Commercial Business;Bedroom;Deck;etc.) Z u U U <br /> Building Contractor: Master Plumber: Z 0 � === <br /> l70 <br /> Anticipated Start Date: 14�J Z <br /> Page 1 of 4 <br /> Burnett County, WI Land Use Application—Rev 3/2016 4 <br />