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LAND USE PERMIT APPLICATION— Burnett County, WI <br /> m Nr <br /> Permit Fees: <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 U <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwellin rinci al Building-Multi-Famil $200 <br /> B <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) £O <br /> Addition to Acc.Structure $150 )Bunkhouse $250 ) rn <br /> Accessory Structure-Commercial(CI &Il) Addition to Accessory Structure-Commercial Cl &Il) $200 <br /> Deck/Stairs/Patio/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 I Allowed) 1 $100 Boathouse $500 w <br /> a <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. � <br /> Applicant Complete All Sections Below This Line c <br /> Applicant's Name: P <br /> Applicant's Mailing Address: P.0 . OY". ?�1 �— C-)flaaf5b :� WI S4 d 1 V <br /> Cit State Zip ,t <br /> PP Telephone <br /> Applicant's s Tel hone Number: c � <br /> 0 <br /> Applicant's Email: W N't 1 Z �. .G(Y\q�� . (1/\ i <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N t <br /> ❑Letter ,Phone ❑Email <br /> Legal Description:_ <br /> N <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR o <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 SLJ <br /> Tax ID#(1-5 digits): <br /> Property Site Address: O 2 jf r&n <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: �� <br /> LlSingle Family Dwelling El Multi-Family Dwelling ❑ Filling/Grading ElCommercial 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 C <br /> ❑ Boathouse ❑ Screen porch–campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway 03 Z z ll l <br /> M <br /> Proposed Structure/Addition Use: G ( �o l Z <br /> (HomefCabin;Commercial Business;Bedroom;Deck;etc.) Z 0 W 4� <br /> CBuilding Contractor: 1 nQ_u1 S Master Plumber: G)®Z Q <br /> Anticipated Start Date: 1p 0'-A – �(� 1 lQ Z <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />