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LAND USE PERNIIT APPLICATION — Burnett County, WI a <br /> Permit Fees: $ o <br /> a <br /> DwellingtPrincipal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Family $200 � O <br /> Dwellin rind al Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaUIndustrial Building $200 �1 <br /> Accessory Structure(Non-Bunkhouse) <br /> Addition to Ace.Structure $150 Bunkhouse $250 - <br /> Accessory Structure-Commercial Cl &Il $200 Addition to Accessory Structure-Commercial Cl &11) $200 <br /> 0 <br /> Deck/Stairs/PalloBetaining Wall/Sidewalk/Driveway& < <br /> Screen orches-in campgrounds only) $125 1 Gazebo WI Stat 59.692(l v)) $350 r <br /> Camping Unit $100 Filling/Grading $150 ° <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 Boathouse $500 <br /> 2 <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. ti <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: 1I e -d Q ✓), (J V 1�J, P �,U a© c. f I�. <br /> Applicant's Mailing Address: W- { ® 7 P <br /> City j State Zip < # <br /> Applicant's ant's TelePhone Number: IL 7 3 3 Dc) <br /> a <br /> d � <br /> Applicant's Email: ? <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. c � <br /> (� ❑Letter WPhone ❑Email <br /> Legal Description: l� t S Lt)O©j� S <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR rD# <br /> Gov't Lot#: OR 1/4 1/4 ` <br /> Section#: Town#: N Range#: W Town of: V v y , <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits): <br /> z <br /> Tax ID#(1-5 digits): �^ � <br /> Property Site Address:_ 296-12- <br /> TYPE <br /> 29672TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: ��Vc`� <br /> El Single Family Dwelling ❑ Multi-Family Dwelling L3Filling/Grading 13 Commercial BuildingQ <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs P(Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(Sv) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> E3Boathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall E3 Sidewalk/Driveway N Z <br /> Proposed Structure/Addition Use: , <br /> (Home/Cabin, ommerciat Business;Bedroom;Deck;etc.) Z u u U <br /> Building Contractor: lJ r Master Plumber: `- G)0 No <br /> Anticipated Start Date: <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 3/2016 <br />