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ell <br /> LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> b <br /> y rt 1 <br /> U. <br /> Permit Fees: C� <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwelling/Principal Building-Multi-Family $200 ^; <br /> CommercialAndustrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(C 1&11) $200 Addition to Accessory Structure-Commercial(C1&11) $200 ) �� <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(Iv)) $350 ne - <br /> Camping Unit $100 Filling/Grading $150 <br /> r^ <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. m <br /> *Communication Towers&Signs require a different applicationform,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. 2 <br /> ro <br /> Applicant Co}riplete'All Sectioris.BelovvT}us Line Ao . <br /> z <br /> Applicant's Name: Q1.1J N 0 VJY 0 <br /> Applicant's Mailing Address: r; & 5 e til <br /> City State Zip ro <br /> Applicant's Telephone Number: � 77 S7 13 <br /> Applicant's Email: S t/Y // /� w <br /> pp k � L <br /> � U,t�IICNL� S�s� • Ca � w , <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> Ii <br /> ❑Letter [Phone Email N i' <br /> 1. a <br /> Legal Description: Die <br /> Lot#: CSM Vol. Pg. OR d <br /> Lot#: Block#: Subdivision Name: OR OW <br /> Gov'tLot#: OR_ 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additionalpage ifneededfor lengthy description OR attach a copy of the deed OR attach tax system propertyPa e. <br /> l, I <br /> Parcel#(24 digits): r, (h <br /> Tax ID#(1-5 digits): {� <br /> Property Site Address#: 7 SU n N <br /> Road Name: L Y N Gd 1 Ij 151 City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: Lbw <br /> ❑ Single Family Dwelling LJ Multi-Family Dwelling ❑ Filling/Grading LJ Commercial Building <br /> ❑ Single Family Addition ❑,Multi Family Addition ❑ Deck/Patio ❑ Commercial Addition D <br /> ❑ Stairs �fy[`�"cc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition 114 C <br /> Proposed Structure/Addition Use: <br /> beJ n <br /> (Homel'(7ahink Commercial Business:Bedroom;Deck:etc.) <br /> Building Contractor: 6Z u u u <br /> O <br /> Anticipated Start Date: <br /> Page 1of4 n11U <br /> Burnett County, WI Land Use Application—Rev 1/2016 ' <br />