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LAND USE PERMIT APPLICATION—Burnett County WI <br /> GuMPU tR/S ANEOP <br /> Permit Fees: v. <br /> Dwell' Building-Single Family $300 Addition to DwellmStPrincipal Budding-Single Family $200 � <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwelling/Principal Budding-Multi-Famil $200 <br /> Commercial/Industrial Building $300 Addition to Commcrcial/lndustrial Building 5200 <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse 5250 <br /> Accessory Structure-Commercial(Cl &11) $200 Addition to Accessory Structure-Commercial(Cl &I1) $200 <br /> Deck/Stairs/Patios $125 1 Gazebo(WI Stat 59.692(lv)) $350 c t <br /> Camping Unit $100 F' Gradin $150 <br /> Permit Extension Valid for one year-Onl IAllowed) $100 a <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. m <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. _. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,retaining walls. <br /> m <br /> z <br /> 0 <br /> Applicant's Name: Q.YVlnpc�tl � p /� ,jm (� 1 ;� f <br /> Applicant's Mailing Address: a " o4..� ! (�o f . Ind ►)/ it k7u r y f l �7p <br /> City State Zip <br /> n d <br /> Applicant's Telephone Number: /( <br /> a � <br /> Applicant's Email: v <br /> w <br /> rn <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter Phone ❑Email N <br /> 0 <br /> Legal Description: <br /> Lot#: r 1—CSM Vo[ c� Pg. <br /> r • - a <br /> Lot#: Block#: Subdivision Name: OR = a <br /> Gov't Lot#: OR 1/4 1/4 70 <br /> L <br /> Section#: Town#: N Range 4.-_4_WCW Town of-.�Jr — <br /> *Attach additionalPage ifneededfor lengthy description OR attach a copy ofthe deed OR attach tax sstemProPenJPage.* y ) <br /> Pueel#(24 digits): 07- 02 ?-^ z 40 - !Ij/- O S/��D5-O D 5- fJzSoE�f It <br /> Tax 1D#(1-5 digits): <br /> r, z <br /> Property Site Address#: _ � �� I <br /> Road Name:�V;WW City:_ <br /> TYPE OF PERMIT(S):Check appropriate box/boxes Fee Rec: f o <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> >$tairs ❑ Acc.Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Aa. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat59.692(ly) ❑Camping Unit ❑ Commercial Acc.Addition W <br /> ` C <br /> Proposed Structure/Addition User( r- Z v <br /> �1 (Nome/Cabin;Commercial Business;Bedroom;D";etc.) ISI <br /> 01 <br /> Building Contractor: e(/2 <br /> N <br /> Anticipated Start Date: C <br /> o <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 112016 C� <br />