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LAND USE PERMIT APPLICATION — Burnett County, WI a <br /> Permit Fees: °a <br /> Dwellin rinci al Building-Single Family $300 Addition to DwellingfPrincipal Building-Single Family $200 C7 <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 O <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 ( a <br /> m <br /> Accessory Structure-Commercial Cl &Il $200 Addition to Accessory Structure-Commercial Cl &Il) $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.6921 v)) $350 c <br /> Cam in Unit $100 Filling/Grading $150 <br /> r <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 /> m <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. <br /> v <br /> Applicant Complete All Sections Below This Line <br /> Applicant's Name: <br /> Applicant's Mailing Address: ����3 3 M��t; �ANQ�;�l S4850 <br /> City State Zip �— <br /> cz\\ fpSl_y1o12�(0 �iS -3S9 - 35S0c z <br /> Applicant's Telephone Number: o N <br /> ` c <br /> Applicant's EmailoNSo`O\�.OtySotJ <br /> w <br /> rn <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. i <br /> b t <br /> _ \\ ❑Letter ❑1Ph1one Email <br /> Legal tion: , T <br /> g P <br /> � <br /> �i.. \roc . tom Ol.1A,Q�.tR. t <br /> Lot#: CSM Vol. Pg. OR o I 1 <br /> 3. <br /> Lot#: Block#: Subdivision Name: OR = t„ <br /> t <br /> Gov't Lot#: OR 1/4 1/4 o <br /> g �L <br /> Section#: �� Town#: N Ran a#:1f W Town of: <br /> *Attach additional a e i needed or lengthy description OR attach a co o the deed OR attach tax system property page. <br /> * N <br /> P 8 f f 8Y P copy Y P P tYP B <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): DI z <br /> I; z <br /> Property Site Address#: o� <br /> Road Name: j �1"`ik �C. City: �✓� �" y <br /> I J � <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:MuGD <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 5 � <br /> ❑ Stairs �8( Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N w <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition <br /> Z D <br /> Proposed Structure/Addition Use: � dGP/ yO 177 <br /> �j (Home/ "bin;Commercial Business;Bedroom;Deck;etc.) -no <br /> I <br /> Building Contractor: 4 S` �c`�'g�QxC��o� M.Z 0 <br /> Anticipated Start Date: W 4 '; o c` S m Z o <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application — Rev 4/2015 a �J <br /> a <br /> m <br /> m <br />