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LAND USE PERMIT APPLICATION—Burnett County, WI g <br /> Permit Fees: $ P to <br /> a <br /> Dwelling/Principal Budding-Sin a Family $3110 Addition to Dwelling/Principal Building-Sin a Family $200 O <br /> DwellingTrincipal Building-Multi-Family $300 Addition to Dwellin ci al Building-Multi-Family $200 m <br /> CommerciaUlndustrial Building $300 Addition to CommercialAndustrial Building $200 <br /> Accessory Structure/Addition to Ace.Structure 4E 50 unkbouse $250 tj <br /> Accessory Structure-Commercial Cl&11 $200 Addition to Accessory Structure-Commercial Cl&11 $200 <br /> Deck/Stairs/Patios $125 Gazebo Stat59.692 ]v $350 g 1 <br /> Camping Unit $100 Fillin Gra ' $150 (n <br /> Permit Extension Valid for one year-Only 1 Allowed $100 <br /> o I <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. a <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,retaining walls. <br /> T _0/3 '. c-o�(.:i (�salJ <br /> Applicant's Name: D f <br /> Applicant's Mailing Address: <br /> City State Zip <br /> Applicant's Telephone Number: 4eS1 33(p biny L.Dx <br /> Applicant's Email: lett l <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. 1 <br /> LetterPhone []Email N 1 <br /> Legal Description: 5 <br /> Lot#: CSM Vol. Z. Pg. I $—� OR <br /> Lot#: Block#: Subdivision Name: OR „ <br /> Gov't Lot#:--4d--OR 1/4 1/4 <br /> Section#: _Town#: I <br /> 1(6 N Range#:_14 _W Town of: t 1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> i <br /> Parcel#(24 digits): r" <br /> 7 <br /> Tax ID# rZ <br /> (1-5 digits): <br /> Property Site Address#: 2 10&9 y <br /> Road Name: ��9 L Ayk E City: <br /> TYPE OF PERMrr(S): Check appropriate box/boxes Fee Rec: 1 00 <br /> ❑ Single Family Dwelling ❑ Mufti-Family Dwelling O Filling/Grading O Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Famity Addition ❑Deck/Patio ❑Commercial Addition <br /> ❑ Stairs )(Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑Commercial Acc.Structure <br /> ❑ Permit Extension ❑ Gazebo—W1 Stat 59.692(ly) ❑Camping Unit ❑Commercial Acc.Addition <br /> ,/ W <br /> Proposed Structure/Addition Use: - QA) 7�J /�j/j <br /> (Home/Cabin;Corhinercial Business:Bedroom;Deck;etc.) G( m M <br /> Building Contractor: CJ\ :4 t <br /> �7—,� � 0 <br /> Anticipated Start Date: 0 0 <br /> Page 1 of 4 Z <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br />