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LAND USE PERMIT APPLICATION-Burnett County, WI b <br /> F+ <br /> Permit Fees: <br /> a <br /> Dweflin rind al Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwellin rind al Buildin -Multi-Famil $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 I <br /> Accessory Structure-Commercial C1&I1 $200 Addition to Accessory Structure-Commercial Cl &Il $200 _ <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& °< <br /> Screenporches-in campgrounds only) $125 Gazebo I Stat 59.692 lv $350 r, <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Permit Extension Valid for one year-Only 1 Allowed $100 Boathouse $500 <br /> m <br /> e <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. ti <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. 7,6c <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: Vic-MP-1V4 <br /> (� Z r <br /> Applicant's Mailing Address: 17 �I_E I,)" p � b6WO G" l�PZV-UE <br /> ro <br /> City State ^Zip c y <br /> Applicant's Telephone Number: (e' to 2)3 `� <br /> 1I6 <br /> Applicant's Email: 5TP,7- pro CD 1.-� <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 'mail ' <br /> Legal Description: o \ <br /> r' <br /> Lot#: ( CSM Vol.._ q "1 OR <br /> Lot#: Block#: Subdivision Name: OR 0 t <br /> Gov't Lot#: OR 1/4 1/4 ql <br /> Section#: Town#: N Range#: W Town of: y <br /> I <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> ' 1� - " OD D 4O0Parcel#(24 digits): 0 7 <br /> r, z <br /> Tax ID#(1-5 digits): <br /> z <br /> Property Site Address: I I gL4-7 P1 OF, L.Rea eD. F-eFD16elt:i LU 1 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:_lSZO-00 <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/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-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway <br /> Proposed Structure/Addition Use: '5-1-t7 A fbe 1 (' �,2 lz <br /> (Home/Cabin;Commercial Business:Bedroom;Deck;etc.) N Z -n< <br /> Building Contractor: PN_QnLO ( 1 L*b IMaster Plumber: <br /> � u � Y <br /> Anticipated Start Dater \T�l ::S"uN E O oN <br /> Page 1 of 4 Z <br /> Burnett County,WI Land Use Application—Rev 3/2016 Z <br /> � <br />