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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> s M " ro <br /> Permit Fees: g Q� <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to DwellingfPrincipal Building-Single Family $200 <br /> DwellinglPrincipal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 v, <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 O <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Acc.Structure $150 Bunkhouse $250 I °� <br /> Accessory Structure-Commercial(Cl &I1 $200 Addition to Accessory 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 <br /> Camping Unit $100 Filling/Grading $150 S <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 Boathouse $500 u <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. o <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. <br /> Applicant Complete <br /> Complete All Sections Below This Line o <br /> Applicant's Name: 1' L <br /> Applicant's Mailing Address: :�—r4rl <br /> CityStalte� zip < # <br /> ` <br /> Applicant's Telephone Number: 0 1 <br /> Applicant's Email: Tc en� L ca ti ,;,, Q+ C72 vti,a, <br /> 1 <br /> v <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter �bne ❑Email ; Qp <br /> Legal Description: <br /> Lot#:_ 7 CSM vol.=�Pg. '-A L OR �' <br /> Lot#: Block#: Subdivision Name: OR F <br /> Gov't Lot#: ORO E 1/4 N 1/4 l <br /> Section#: Town#: _N Range#: �_�W Town of: Q J S V_ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tar system propertypage. <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): <br /> Property Site Address. Ads A r r <br /> TYPE OF PERMIT(S): Check appropriate box/tfoxe e , s <br /> Fee Reca� <br /> mangle Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading El Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> 13 Permit Extension E3 Gazebo-WI Stat 59.692(ly) Ll Camping Unit ❑ Commercial Acc. Addition C <br /> ❑ Boathouse ❑ Screen porch-campgrounds only ❑(�Retaiininng Wall ❑ Sidewalk/Driveway M :[> <br /> Z C— <br /> Proposed Structure/Addition Use: H O`t'i'e- � `JeA^ O —mj c <br /> (H <br /> ome/Cabin;Commercial Business;Bedroom;Deck;etc.) Z —I ND FR <br /> Building Contractor: aer Vi 8Y'c c. (^Ny+ ShC Master Plumber: 00 _o <br /> Anticipated Start Date: Z flfl <br /> Page 1 of 4 U <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />