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LAND USE PERMIT APPLICATION - Burnett County, WI 9: c <br /> s - b <br /> y H Fr <br /> Permit Fees: g Q� <br /> a <br /> Dwellin rinci al Building-Single Family $300 Addition to Dwell in rinci al Building-Single Family $200 O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $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 Cl &11) $200 Addition to Accessory Structure-Commercial CI &11) $200 <br /> Deck/Stairs/Patio/Retaining Wa1USidewalk/Driveway& 0 <br /> Screen orches-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 year-Only 1 Allowed) $100 Boathouse $500 d <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. ) <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Applicant Complete All Sections Below This Line o <br /> J` Applicant's Name: fi / V f d <br /> Applicant's Mailing Address:�r7� V D s✓f)///j �/; ��I� f�(J/'t/ W/J�yy o <br /> State Zip <br /> +� Applicant's Telephone Number: <br /> 0 <br /> d <br /> Applicant's Email: <br /> 1 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N YQ <br /> ❑Letterhone ❑Email <br /> Legal Description: o <br /> Lot#: CSM Vol. �— Pg. _ OR y <br /> I <br /> Lot#: Block#: Subdivision Name: OR rr F <br /> Gov't Lot#: OR 1/4 1/4 1 C� <br /> Section#: Town#:�1 �N Range#:_LS_W Town of., \/J%s� y <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> a <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): <br /> Property Site Address: l�d 1 t?S rn. �r ' U) <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: 50 <br /> LJ Single Family Dwelling EJ Multi-Family Dwelling L3Filling/Grading Ll Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> 0 <br /> ❑ Stairs 9,Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo–WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition <br /> L3Boathouse E3Screen porch–campgrounds only LlRetaining Wall LlSidewalk/Driveway C <br /> 1_ C x, FrH <br /> Proposed Structure/Addition Use: �J(^� I <br /> r \ \ (Ho abin;Commercial Business;Bedroom;Deck;eta) <br /> XV <br /> Building Contractor: /V ���1 10 0, f Master Plumber: n _ <br /> Anticipated Start Date: ® rn <br /> Page Iof4 Z Uuu <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />