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LAND USE PERNUT APPLICATION— Burnett Count, WI r <br /> -Nn H H <br /> Permit Fees: c to <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 d <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaVlndustrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(C1&11) $200 Addition to Accessory Structure-Commercial Cl&11) $200 <br /> Deck/Stairs/Patios 1 $125 1 Gazebo(WI Stat 59.692(ly) $350 _ c <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 or <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. n <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 /> ° <br /> Applicant Complete All Sections Below This Line o . <br /> RI C IC C(ZA� <br /> Applicant's Name: ( C• � I` <br /> Applicant's Mailing Address: 1 a' ST- <br /> J—l S tr� .y�0� t• I KS M W 'S1 DI <br /> City State Zip ro <br /> Applicant's Telephone Number: y ( 2- <br /> C <br /> 0. <br /> Applicant's Email: a l <br /> w <br /> rn <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. SOr <br /> ]Letter Phone []Email N °° <br /> o t <br /> Legal Description: <br /> Lot#: -CSM Vol. Pg. OR o <br /> N <br /> p 3. <br /> Lot#:0 Block#: Subdivision Name: I a b OR y <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: 1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> I <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): ••�� Z <br /> qqgProperty Site Address#: L— n <br /> Road Name:- rArcC. m ) L` 1`l?pIf) City: �AtJi3� P,`j <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:�acn <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> 'o <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc.Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> / 0 <br /> Proposed Structure/Addition Use: tc_4&) ^© A&A 6C, a W <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) m <br /> Building Contractor: Z o <br /> Anticipated Start Date: <Z s� <br /> r <br /> Page 1of4 070 <br /> Burnett County, WI Land Use Application—Rev 4/2015 n Z "' II <br /> z <br /> m <br /> m <br />