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LAND USE PERMIT APPLICATION— Burnett County, WI a b <br /> y <br /> Permit Fees: ; c x~!t <br /> a <br /> Dwelling/Principal Building-Sin le Family $300 Addition to'DwellinglPrincipal Building-Sin le Family $200 � O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> m <br /> Commercial/Industrial Buildin $300 Addition to Commercial/industrial Buildin $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> t <br /> Accessory Structure-Commercial CI &II) $200 Addition to Accessory Structure-Commercial(Cl &Il) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692 1 v)) $350 c <br /> Camping Unit $100 Fillinc/Gradin <br /> $150 <br /> Permit Extension Valid for one year-Only I 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 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 /> ^o <br /> Applicant Complete All Sections Below This Line �. <br /> /�, z <br /> Applicant's Name: 6 S 0 (� �4,(A f Ot,❑ tr42 1�K l K . 0 <br /> Applicant's Mailing Address:—2 1 `jIQ I rt'ir�r[pl(1� L(,QT �1 <br /> l� City State zip n U) <br /> Applicant's Telephone Number: �J ' 3 Z1 - S �� T o y C> <br /> U)c <br /> a � <br /> Applicant's Email: 1Iow5LO ill)rVX 1 v <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter E4Phone ❑Email o <br /> Legal Description: R <br /> Lot#: CSM Vol. Pg. OR v <br /> G• 1 <br /> Lot#: Block#: Subdivision Name: OR „ (� <br /> I <br /> Gov't Lot#: OR 1/4 4 v1 <br /> Section#: Town#: �N Range#: W Town of: Imp Ir _ J <br /> *Attach additionalpage i needed or lengthy description OR attach a co o the deed OR attach tax system ro er a e.* y <br /> Pag .r f g Y P PY .l• Y P P tYP g <br /> W <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): c�3 <br /> Property Site <br /> CAddress#: U �J <br /> Road Name:S rr City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: _J dov <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> ❑ Stairs Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure c <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition Y C <br /> / l n 7D �inl <br /> Proposed Structure/Addition Use: S (O[ �/r 10�� J(0�--30 a z m <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) C O -O <br /> '/ / Q � Z <br /> aA <br /> Building Contractor: (/`djJt 74�1Atj(N� �A Qwl Z do <br /> v <br /> Anticipated Start Date: 6 C1 t �- (S m <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> 3 <br /> o <br /> x <br /> m <br /> A <br /> m <br />