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LAND USE PERMIT APPLICATION—Burnett County, WI a _ <br /> N N <br /> Permit Fees: 0 c '� <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwellin rinci al Building-Single Family $200 G <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwellin rinci al Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 rr-� <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 y <br /> Accessory Structure-Commercial(CI &Il) $200 Addition to Accessory Structure-Commercial Cl &Il) $200 <br /> Deck/Stairs/PadoS 1 $125 Gazebo(WI Stat 59.692(iv)) $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. n <br /> w <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 /> CC z <br /> Applicant's Name: / `t E4Zt a y <br /> Applicant's Mailing Address: ` 2 MJ I(�N p 1 Sf PAtJ/ CF I c � ��Q7/ <br /> / G-7 City State Zip o <br /> Applicant's Telephone Number: 6,5_1 �/ / --3S30 o z <br /> y <br /> Applicant's Email: SM <br /> a w <br /> m <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> 1 <br /> [—]Letter Phone ❑Email N <br /> 0 <br /> Legal Description: ' ) <br /> Lot#: CSM Vol. Zy Pg. OR o <br /> Lot#: Block#: Subdivision Name: OR = „ <br /> 1 <br /> Gov't Lot#: OR 1/4 1/4 1 <br /> Section#: 3 7 Town#:_�N Range#: 16 W Town of: /QH a� 70 <br /> l 7 <br /> *Attach additional page if needed or lengthy description OR attach a copy of the deed OR attach tax system propertyPage.* -3 1 <br /> Parcel#(24 digits): <br /> z <br /> Tax ID#(1-5 digits): 3 ?1/70 <br /> Property Site Add�dress,#: 67,3q G (� ) / / <br /> Road Name: rzij.uT f I.rl 7r f1 l5 !moi 1C.L City: (NIS b5h w <br /> TYPE OF PERMIT(S): Check appropriate box/boxes <br /> Fee Rec: <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family AdditionADeck/Patio ❑ Commercial Addition y <br /> 0 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition <br /> y <br /> C <br /> Proposed Structure/Addition Use: nF C <br /> ym M <br /> (Hoe/Cabin;Co cial Business;Bedroom;Deck;etc.) Z <br /> E -4Building Contractor: Q R todcw �M i.� _WC Z <br /> As <br /> Anticipated Start Date: As A� 0 o_ <br /> Page 1 of 4 m a (� <br /> Burnett County, WI Land Use Application—Rev 4/2015 <br /> x <br /> m <br /> A <br /> m <br />