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LAND USE PERMIT APPLICATION —Burnett County WIal <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 a <br /> $300 Addition to Dwellinrincial Building Multi-Family Buildin -Multi-Famil $200 °^ <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 Q) <br /> Accessory SWcture(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &Il $200 1 Addition to Accessory Structure-Commercial Cl &II $200 <br /> Deck/Stairs/Patio/Retaining WalUSidewalk/Driveway& 0 1 1 <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(l v)) $350 <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Permit Extension Valid for one year-Only I Allowed $100 Boathouse $500 y <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. o <br /> *Items not listed above will be treated as accessory structures,such as:pergolos, landscaping,etc. <br /> Applicant Complete All Sections Below This Line o a <br /> Applicant's Name: tat 1r^ r <br /> Applicant's Mailing Address: �001 Q Ir s'� . � A Y\10 .�r u W� Jt'�s3(j o <br /> Ci State zip <br /> Applicant's Telephone Number: q 15 — S 6L — 3 7 <br /> v <br /> Applicant's Email: par , r, 1 g y fn G) G rnCU, ( C OYr, <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> ❑Letterhone ❑Email <br /> P <br /> ac <br /> Legal Description: o <br /> Lot#: ,2 CSM Vol.—a.6 Pg.3 l 3�K OR <br /> Lot#:_ Block#:_ --Subdivision Name_ OR <br /> Gov't Lot# OR 1/4 1/4 1 <br /> Section#: C) Town#:_Lq 0 N Range#:___L_ia_W Town of 0 q,k Q n A �' 1 <br /> *Attach additional page ifn�eeddeed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits): / V / ` <br /> Z <br /> Tax ID#(1-5 digits): IV A <br /> Property Site Address:__ <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes <br /> Fee Rec:� 5Q <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs )KAcc. 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—campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway C <br /> Proposed Structure/Addition Use: St O rq Q L -?C) 1 e, A.Y• 1'N Z o� <br /> (Nome bin;Commercial Business;Bedroom;Deck;etc.) O 171 —� <br /> ` I <br /> Building Contractor: jVO C�'r�I4 n �U t d I MS Master Plumber: N f Z n �, U u�lf <br /> Anticipated Start Date: G) O o <br /> Page 1 of 4 <br /> Z <br /> Burnett County,WI Land Use Application—Rev 3/2016 4 (�"—� <br />