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LAND USE PERMIT APPLICATION— Burnett County WI <br /> i► a - b <br /> y ^ 1 <br /> h �1 <br /> Pertitit Fees: g" <br /> Ir. IF, <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 b <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) <br /> Addition to Ace.Structure $150 Bunkhouse $250 e°s <br /> Accessory Structure-Commercial(Cl &11) $200 Addition to Accessory Structure-Commercial CI &11) $200 <br /> C) <br /> Deck/Stairs/Pabo/Retaining Wall/Sidewalk/Driveway& <br /> Screen orches-in campgrounds only) $125 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 /> Tr <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. W <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. 2 <br /> ro <br /> *items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. c <br /> / <br /> Applicant Complete All Sections Below This Line o <br /> Applicant's Name: ls+��✓t t fC i[eG,41-Q <br /> 6r <br /> Applicant's Mailing Address: 12-13 /k.+orYQ LG�j S�cl�'� ro <br /> City State Zip < <br /> O <br /> Applicant's Telephone Number: <br /> b <br /> Applicant's Email: 7—/./<U trLl1 G 1542 Gem <br /> ro � <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. N °A <br /> ❑Letter Phone ❑Email <br /> Legal Description: / Lail% y �o�,r �/�+ �S may,L¢f 3 n <br /> Lot#:�_CSM Vol. g. OR <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: 3 OR 1/4 1/4 <br /> Section#: 45iLV Town#:_90 N Range#:__I'C/ W Town of. <br /> 1 <br /> *Attach additional page if needed for lengthy description <br /> OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits): <br /> e <br /> z <br /> Tax ID#(1-5 digits): <br /> Property Site Address: 1,;?/3 A're /v <br /> i <br /> s <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> co <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) L3Camping Unit LlCommercial Acc.Addition <br /> LIBoathouse ❑ Screen porch-campgrounds only ❑ Retaining Wall ❑ Sidewalk/Driveway 013 7�) <br /> Proposed Structure/Addition Use: Allo &Or✓h co VTU <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) m <br /> mU <br /> Building Contractor: 45�P— A7 Master Plumber: <br /> 0Anticipated Start Date: N <br /> C--:::,_ <br /> Page 1 of 4 Z CT) (� <br /> Burnett County,WI Land Use Application—Rev 3/2016 4 �� <br />