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LAND USE PERMIT APPLICATION— Burnett County,WI a _ b <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 m <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Ace.Structure $150 Accessory Structure or Bunkhouse $250 E <br /> Accessory Structure-Commercial(Cl &11) $200 Addition to Accessory Structure-Commercial(C 1 &Il) $200 1 <br /> Deck/Stairs/Patios $125 Gazebo Wl Stat 59.692(lv)) $350 0 <br /> Camping 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. ti <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 /> v <br /> so <br /> Applicant Complete All Sections Below This Line c �_ <br /> Applicant's Name: <br /> Applicant's Mailing Address: e- . 11-15,qlle / 400� Ze;M�I 4"Lt S I-2 <br /> City State Zip W �_ <br /> Applicant's Telephone Number: <br /> 0 GN <br /> Applicant's Email: J Orn4a n k56 h as f@ h04-ma i 1. 0 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter g4Phone %Email c 00 CO <br /> Legal Description: l <br /> Lot#: CSM Vol. Pg. OR <br /> N <br /> Lot#: Subdivision Name: OR a N <br /> Gov't Lot#: A OR 1/4 1/4 1 <br /> Section Town#: z / N Range#: W Town of: <br /> •Attach additional page if needed for lengthy description OR attach a cop�yl of the deed. <br /> � <br /> Parcel#(24 digits): J - 1)3`� - '[��-/ S-�;ZoC '5����� C97rn <br /> Tax ID#(1-5 digits): L <br /> Property Site Address#: L y U) d <br /> Road Name: Z Ile[ ��/U � City: n T - <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Recr�� <br /> Single Family Dwelling ❑ Multi-Family Dwelling Ll Filling/Grading L3Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> 0 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> 0 <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) L3 Camping Unit L3 Commercial Acc.Additionz a) <br /> cT <br /> Proposed Structure/Addition Use: <br /> > Z <br /> A, (� Z <br /> (Home/Cabin;Commercial Business;Bedroom:Deck etc.) 4N <br /> 14 <br /> 00 <br /> Building Building Contractor: 7 1 <Z Ir <br /> f - nZo N C <br /> Anticipated Start Date: y o <br /> Page 1 of 4 o Z ���]] <br /> Burnett County,WI Land Use Application—Rev 3/2015 ; r <br /> x <br /> M <br /> A <br /> M <br />