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LAND USE PERMIT APPLICATION— Burnett County, WI a b <br /> N 1� <br /> Permit Fees: 1a` <br /> DwellinglPrincipal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family $ Addition to Dwellin nci al Buildin -Multi-Famil $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 0 <br /> Accessory Structure(Non-Bunkhouse) E <br /> Addition to Acc.Structure $150 Bunkhouse $250 <br /> AccessoryStructure-Commercial Cl&I1 $200 Addition to AccessoryStructure-Commercial C 1&I1) $200 <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk/Driveway& $$- <br /> Screen orches-in campgrounds only) $125 Gazebo WI Stat 59.692 Iv $350 r <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only I Allowed $100 Boathouse $500 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal tee. ' <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 <br /> o <br /> Applicant Complete All Sections Below This Line o <br /> 11 <br /> Applicant's Name: ZtA ACr t S G M t e G <br /> Applicant's Mailing Address: l V r-�� Ss 3 K Y (� 1 it� (.�'U r i t-1 � v <br /> City State Zip o z <br /> N <br /> �s � - <br /> Applicant's Telephone Number: 1 -7g <br /> d <br /> d <br /> Applicant's Email: r A t1 Ct S G l t r, e u cc A vc rV l.n K .C o r'11 i <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N a4 <br /> ❑Letter Phone ❑Email <br /> w <br /> Legal Description: 'L,5 A S t `/S o (3, <br /> 5. <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#:_ A OR 1/4 1/4 1 <br /> Section#: / q Town#: N Range#: W Town of: 7Ht, Ks V^ Twp_ <br /> *Attach additional a e i needed or lengthy description OR attach a co o the deed OR attach tax system property page.* 1 <br /> Pg f .f gY P copy Y P P YPg "QI �- <br /> r� G <br /> Parcel#(24 digits): z as 3 <br /> Tax ID#(1-5 digits): 3 19 <br /> Property Site Address: Q80,1-1 l <br /> c <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: 5 O <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/� C t_ <br /> Proposed Structure/Addition Use: S�4 f-1,r Sb r ti.t,� z � Gil <br /> (Flome/Cabin:Commercial Business:B room;Deck:etc.) N rn � � / <br /> Building Contractor: Master Plumber: Z n ra <br /> Anticipated Start Date: C ER <br /> C:0 <br /> Page 1 of 4 Z Cn <br /> Burnett County,WI Land Use Application—Rev 3/2016 `�`—� <br />