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LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> � C <br /> < - b <br /> Permit Fees: 0 o� <br /> a <br /> Dwelling/Principal Building-Single Famil $300 Addition to Dwelling/Principal 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) OCI <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial C1 &Il $200 Addition to Accessory Structure-Commercial Cl &I 1 I $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& o <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692(l v)) $350 S, <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only I Allowed) $100 Boathouse $500 w <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. d' <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> ro <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 /> Applicant's Name: fe 1 �— /�/a k e--- <br /> Applicant's Mailing Address: <br /> PO 30K Y;L7 6Z0_07S 01x1 V/ A?t, ro <br /> City State zip <br /> O_ y <br /> Applicant's Telephone Number: <br /> r_ d <br /> Applicant's Email: )FCC44Irt ett raj.. tr ✓r' . QOM <br /> T <br /> b I <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> ❑Letter ❑PhoneEmail '- <br /> Legal Description: / - R <br /> y <br /> Lot#: CSM Vol. Pg. OR <br /> � 1 <br /> Lot#: Block#: Subdivision Name: OR Ip \ o <br /> Gov't Lot#: OR 1/4 1/4 7 <br /> Section#: Town#: N Range#: W Town of: <br /> H I <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* I <br /> Parcel#(24 digits): <br /> � z I <br /> Tax ID#(1-5 digits): 01��'� /� ,` u y �' <br /> Property Site Address:_ 2/Q cola i cky y/e/t, ,�r C/t1WI W,* SVQya <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <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 C ✓�—r <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway iN ZM 3> <br /> Gac <br /> ra l e rJ <br /> Proposed Structure/Addition Use: <br /> (Home abin;Commercial Business;Bedroom;Deck:etc.) dD r7 <br /> Building Contractor: -AMet ,� C/t-E SL LCJ�aster Plumber: z c <br /> Anticipated Start Date: ZD /� <br /> Page 1 of 4 <br /> Burnett County, WI Land Use Application—Rev 3/2016 <br />