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1 10 <br /> LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> PW <br /> Permit Fees: 0 <br /> 6 71 <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <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 Stmcture(Non-Bunkhouse) l <br /> Addition to Acc.Structure <br /> $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(Cl &Il) $200 Addition to A cessory Structure-Commercial Cl &I l $200 1;Z 1 <br /> Deck/Stairs/Pado/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 y <br /> w <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. a <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,etc. <br /> Applicant Complete All Sectio Below�This Line o <br /> Applicant's Name: a< �� cQ <br /> �. <br /> Applicant's Mailing Address: .2 6 S t Cv r 1 /Ol v 2— Il al // JAS(f b <br /> City State Zip 2 <br /> Applicant's Telephone Number: / <br /> / d <br /> Applicant's Email: dt) eft-4 ( %F l/ QI31.(r [ ,Gp n^ <br /> 'v <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N <br /> ❑Letter one Email g• <br /> Legal Description: S @az_ Q _ r <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR c <br /> F <br /> Gov't Lot#: OR 1/4 1/4 1 <br /> Section#: Town#: N Range#: W Town of: ~ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> Parcel#(24 digits): 1 <br /> n z <br /> Tax ID#(1-5 digits): (,� y <br /> Property Site Address: 8 q a {� ����jat�1 R•, U e*— R O� <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 � <br /> ❑ Boathouse ❑ Screen porch—campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway C <br /> Proposed Structure/Addition Use:�� Z CH <br /> �(Hom abin;Commercial Business;Bedroom;Deck;etc.) <br /> Commercial Business;Bedroom;Deck;etc.) r l7 CJ <br /> Building Contractor: Master Plumber: <br /> N <br /> Anticipated Start Date: C rn <br /> Page 1 of 4 Z f 111 <br /> Burnett County,WI Land Use Application—Rev 3/2016 4 <br />