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LAND USE PERMIT APPLICATION —Burnett County, WI a <br /> z <br /> H N <br /> Permit Fees: <br /> a � <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 17 <br /> d <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwelling/Principal Building-Multi-Famil $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 V 1 <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse $250 1 <br /> Accessory Structure-Commercial(C 1 &11) $200 Addition to Accessory Structure-Commercial(C 1 &11) $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& o <br /> (Screen porches-in campgrounds only) $125 Gazebo(Wl Stat 59.692(l v)) $350 r, <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Permit Extension(Valid for one year-Only 1 Allowed) 1 $100 Boathouse $500 m <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 Qjerent application.form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> ��d Applicant Complete All Sections Below This Line o <br /> rl, <br /> nt's Name: C� ALJ i C SO I tCJC <br /> Applicant's Mailing Address: 13 �t S •Jbwboay lj� S41930 r) v <br /> City State Zip <br /> Applicant's Telephone Number: /--7 1S <br /> � o <br /> Applicant's Email: '(dao u.;; (It os-lku ►J J t, ryx f, I t . O.Q. <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N 00 1 <br /> ❑Letterhone [Email <br /> P5 ) <br /> Legal Description: v 1 <br /> ti <br /> Lot#: CSM Vol. Pg. OR S. <br /> Lot#: Block#: Subdivision Name: OR 71�3 go <br /> F 1 <br /> Gov't Lot#: OR 1/4 1/4 ° <br /> Mp I <br /> Section#:�`�Town#:-,3 7—N Range#:--Ue W Town of: tj <br /> *Attach additional page if neededfir lengthy description OR attach a copy ofthe deed OR attach tax system propertt•page.* VV t <br /> r <br /> Parcel#(24 digits): <br /> n z I <br /> Tax ID#(1-5 digits): <br /> Property Site Address: (0(J U IFFE se)ti <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec. 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(iv) ❑Camping Unit ❑ Commercial Acc.Addition �,�'�■"� <br /> ❑ Boathouse ❑ Screen porch—campgrounds only ❑ Retaining <br /> /Wall ❑pSidewalk/Driveway W <br /> Proposed Structure/Addition Use: ee)mL fir✓ ' 1,4 Z <br /> (Home/Cabin;Commercial Business:Bedroom:Deck:etc.) IV M C- <br /> � qq 1 <br /> Building Contractor: en UV I t_.3o tJ Master Plumber: Z <br /> Anticipated Start Date: G) 0 o <br /> Pagel of 4 Z lvl <br /> Burnett County,WI Land Use Application-Rev 3/2016 <br />