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LAND USE PERMIT APPLICATION— Burnett County WI a <br /> ro <br /> Permit Fees: o' <br /> 5 <br /> Dwelling/Principal Building-Single Familyn <br /> $300 Addition to Dwelling/Principal Princi al Buildin -Sin le Family $200-,, <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> CommerciaUlndustrial Building $300 Addition to Commercial/Industrial Building $200 (}� <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 ` <br /> Accessory Structure-Commercial Cl &11) $200 Addition to Accessory Structure-Commercial Cl &Il) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(lv)) $350 o <br /> Camping Unit $100 Filling/Grading <- <br /> $150 _ <br /> Permit Extension Valid for one year-Only 1 Allowed $100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. <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. d <br /> 'v <br /> Applicant Complete All Sections Below This Line �. <br /> 1� z <br /> Applicant's Name: w 114 bl^n W nnw <br /> Applicant's Mailing Address: <br /> 1 (0130 `Zn::A"cQ 6 cVL &Q o S •� <br /> ham_) City State Zip Con ` <br /> Applicant's Telephone Number: � (0 90(C ) `S ks 1C)ql� � o y '� <br /> Applicant's ant'sEmail: << ' r\StJ• CD lO N3 15t_J71�•ll\Ld _ <br /> ^p t <br /> m <br /> io <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter [*hone °o <br /> ❑Email N <br /> Legal Description:(O &:3 tp C/l � 91 <br /> Lot#: CSM Vol.�62�2 9. OR V 13 ('t 3i <br /> Lot#: Block#: Subdivision Name: OR ICA <br /> Gov't Lot#: R 3 1/4 1/4 f 1 <br /> Section#: Town#: N Range#: W Town of: i o <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertypage.* y <br /> Parcel#(24 digits): CO- 0,:)D-a -90- 1(o-14-5 o5—ODS- ok Room <br /> x <br /> 2 � z <br /> Tax ID#(1-5 digits): <br /> N <br /> N <br /> Property Site Addres #: <br /> Road Name: u6nbi f YJ (L City: ('*KkAS!D <br /> TYPE OF PERMIT(S): Check appropriate box/boxes <br /> Fee Rec:QOD,co <br /> ❑ ingle Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ingle Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> 0 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> L3Permit Extension ElGazebo–WI Stat 59.692(ly) L3Camping Unit L3Commercial Acc.Addition 4 C <br /> n � <br /> Proposed Structure/Addition Use: y � <br /> P St <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 'm'C) <br /> z <br /> Building Contractor:&IZ- <br /> Anticipated Start Date: <br /> Page 1 of 4 0 <br /> Burnett County, WI Land Use Application—Rev 4/2015 <br /> 3 <br /> v <br /> s <br /> m <br /> A <br /> M <br />