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LAND USE PERMIT APPLICATION— Burnett County, WI e i b <br /> N ^ <br /> Permit Fees: o P o� <br /> DwellinglPrincipal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> O <br /> DwellinglPrincipal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 g <br /> CommerciaVlndustrial Building $300 Addition to CommerciaUlndustrial Building $200 v <br /> Accessory Structure/Addition to Ace.Structure Bunkhouse $250 <br /> Accessory Structure-Commercial(Cl&[1) $200 Addition to Accessory Structure-Commercial(CI&I I) $200 1 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(l v). $350 c <br /> Camping Unit $100 1 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only1 Allowed) $10 <br /> 0 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. v <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. _ <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. <br /> ro _ <br /> Applicant Complete All Sections Below This Line c . <br /> e 1—t o <br /> Applicant's Name: 1 konn e V <br /> Applicant's Mailing Address: 7 <br /> C. <br /> My State Zip ro <br /> Applicant's Telephone Number:_ �� <br /> c <br /> a <br /> Applicant's Email: o <br /> m <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ro <br /> o ❑Letter hone ❑Email t�.� <br /> Legal Description: `IVrM Ov� la f 1 lata Ir1t• 1\ Co jets 1 ' <br /> Lot#: CSM Vol. Pg. OR <br /> 5. <br /> Lot#: Block#: Subdivision Name: OR } J <br /> Gov't Lot#: OR 1/4 1/4 l <br /> Section#: Town#: N Range#: W Town of: <br /> l <br /> *Attach additionalPage if needed or lengthy description OR attach a copy ofthe deed OR attach�ta+x <br /> system <br /> properly <br /> 40Parcel# 24 digits): <br /> �y 000 n z <br /> Tax ID#(1-5 digits): C� <br /> Property Site Address#: 0M <br /> O 1, <br /> Road Name: WQ 5-t-- e( pVM'�t/ City: Q <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: � t-) <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs Acc.Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> N <br /> ❑ Permit Extension ❑ Gazebo—WI Stat159.692(ly) ❑Camping Unit ❑ Commercial Acc.Addition C 1 <br /> Proposed Structure/Addition Use: <br /> (Home/Cabin;Commercial Busin s; edroom;Deck;etc.) Z <br /> Building Contractor. Z -1 W <br /> Anticipated Start Date: 4 `$� (n 0 O s �IJ <br /> Page 1 of 4 o Z <br /> Burnett County,WI Land Use Application—Rev 1/2016 <br /> z <br /> m <br /> m <br />