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LAND USE PERMIT APPLICATION— Burnett County, WI r <br /> g a � <br /> < - b <br /> Permit Fees- °� a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 9 3 <br /> d <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 � O <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure(Non-Bunkhouse) O <br /> Addition to Ace.Structure $150 Bunkhouse $250 1 9 <br /> Accessory Structure-Commercial(Cl &I I) $200 Addition to Acccssory Structure-Commercial Cl&11) $200 ~ <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 <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. JI <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. y <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping, etc. r <br /> o - <br /> Applicant <br /> ,Complete All Sections Below This Line o <br /> Applicant's Name: M i c-A It E <br /> Applicant's Mailing Address: 4OD LLx e r, S_!_, /V A'p�_/23 `rP4 itL M ✓ 5�//�/ 9 <br /> City State Zip <br /> o y <br /> Applicant's Telephone Number: 6/?-27J0 9 4-AS- <br /> Applicant's Email: hi k) ?-2..t/ eo— �/11 Cr}�. Le A4 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> ❑Letter hone ❑Email o lJ <br /> oS, <br /> o <br /> Legal Description: d 4- <br /> Lot#: CSM Vol. /s Pg. S­4- OR 2 <br /> Lot#: Block#: Subdivision Name: OR o" <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: 311-_Town#:�N Range#: ....LIL W Town of: ,SC V JT <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Parcel#(24 digits): 6 ]-�2� 'Z�7`' -0-34--f 05_-00S_--014000 V_ 4t <br /> � z <br /> Tax ID#(1-5 digits): /'e- <br /> C <br /> Property Site Address: 2 7¢/© /e 1 ty,4 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes <br /> Fee Rec: ASO <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 /> C <br /> Proposed Structure/Addition Use: GA-kA -2L M <br /> (Home/Cabin;Commercial Business:Bedroom;Deck;etc.) N Z �G <br /> MM II J <br /> Building Contractor: /"t r(rFt Q el y4 z,2 itZ/ Master Plumber: <br /> Z n <br /> Anticipated Start Date: 0(��/$' //„ G) Q <br /> Page 1 of 4 C" <br /> Burnett County, WI Land Use Application—Rev 3/2016 <br />