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LAND USE PERMIT APPLICATION —Burnett County, WI a_ <br /> Permit Fees: o� <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwel1m ci Buil -Single Family 5200 a' O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwettin c' Building-Multi-Famil $200 A <br /> CommerciaUlndustrial Builth $300 Addition to Commercial/Industrial Building $200 v O <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Y <br /> Accessory Structure-Commercial(Cl&Il) SIAO Addition to Accessory Structure-Commen;ial C]&Il) $280 1:: i <br /> Deck/Stairs/Patios $125 Gazebo Stat 59.692 Iv $358 O <br /> Camping Unit $100 Fillip Gradin $158 g- <br /> 0 <br /> Permit Extension slid for one yearZ Only 1 Allowed $100 e <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee rn <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> i <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,Landscaping,retaining walls. <br /> ro <br /> Applicant Complete All Sections Below This Lune . <br /> r c <br /> Applicant's Name: ✓/ Q <br /> Applicant's Mailing Address: ,I *#NA274114Q- GIA- N,B tol✓�.Q �l�fS3y� <br /> City State Zip ro <br /> z <br /> Applicant's Telephone Number: 6/2- <br /> Applicant's Email: >� Lo^114141 G C-4 pAV Z Arol . 4[4— ^IDS <br /> If staff has a question about this application Low do you prefer to be contacted? Check one below. i <br /> QLetter DKone mail � <br /> o� <br /> Legal Description: a <br /> Lot#: CSM Vol. Pg. OR q <br /> 3. <br /> Lot#: Block#: Subdivision Name: OR „ <br /> Gov't Lot#: OR 1/4 1/4 1 F <br /> Section#: Town#: r!�o 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 property page. <br /> Parcel#(24 digits): D - O 2- <br /> Tax <br /> Tax ID#(1-5 digits): r m a <br /> � y <br /> Property Site Address#: Z 3 s a <br /> GOww � Zrp4ol � <br /> Road Name: City: <br /> TYPE OF PERMrr(S): Check appropriate box/boxes Fee Rec:!SCO,00 <br /> ❑ Single Family Dwelling E3Mutd-Family Dwelling El FIAng/Grading LlCommercial Building i� <br /> Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> 0 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure �' Q <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑Camping Unit ❑ Commercial Acc.Addition m �� <br /> n <br /> po A A04/ - y I / f S� Z <br /> Pro sed Structur�e/Addition Use: eG,�,<Gft� �- Elf �o � 0. -j � <br /> (HomelCabin;Commercial Basmms;Bedroom;Deck-etc.) A r U <br /> Building Contractor: ^II tri uQ�t7t <br /> " N <br /> Anticipated Start Date: y jr 4P 1�Or� ,oe C rn <br /> Page 1 of 4 Z <br /> Burnett County,WI Land Use Application—Rev 1/2016 <br /> m <br />