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LAND USE PERMIT APPLICATION —Burnett County, WI a 0 b <br /> y. 1 <br /> Permit Fees: = n <br /> Dwelling/Principal Building-Single Family $300 Addition to DwellingfPrincipal Building-Single Family $200 C7 <br /> DwellingtPrincipal Building-Multi-Family $300 Addition to DwellinglPrincipal Building-Multi-Family $200 7 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessoty StructurelAddition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial CI &Il $200 Addition to Accessory Structure-Commercial Cl &II $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(l v)) $350 c <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. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. '- <br /> d <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 <br /> 0 <br /> Applicant's Name: dep d. A // <br /> Applicant's Mailing Address:D Y.) �G,Lr� �' !r /G�C�Ce c _�fr ti!xc f✓,l,�i <br /> City Sate Zip <br /> Z <br /> Applicant's Telephone Number: S y�3 v o c <br /> a \ <br /> Applicant's Email: �cZ•Y h./L �� ,j yi ,,� �i'( ' , C "'•�, p <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter ,Phone ❑Email N 00 <br /> 1 ° <br /> Legal Description:r4 c .S btu N C tCT/,w /V wate A✓F moi.S L:./^fy/ 7' <br /> Lot#: CSM Vol. Pg. OR Nol"I, d ettl y l 1'A✓JaWI � v <br /> Lot#: Block#: Subdivision Name: OR Y a, <br /> Gov't Lot#: OR 1/4 1/4 f <br /> Section#: Town#: N Range#: W Town of: i <br /> *Attach additional page if needed or lengthy description OR attach a copy of the deed OR attach tax system propertyPage.* -a <br /> � <br /> Parcel#(24 digits): <br /> ° <br /> Tax ID#(1-5 digits): z <br /> z <br /> Property Site Ad #: 39 ,3.2 ;7— // <br /> Road Name: r c r r City: Qc(Lr/ 4 yt/ <br /> TYPE OF PERMIT(S Check appropriate box/boxes Fee Rec:�.L� <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> y <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 5 <br /> ❑ Stairs )0 Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N v <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition 4 C <br /> 2 nFn <br /> Proposed Structure/Addition Use: 21 r: m <br /> (Ho a/Cabin;Commercial Bus' ess;Bedroom;Deck;etc.) 4 �': c.✓ <br /> Building Contractor: 0 �, r <br /> � cV� <br /> Anticipated Start Date: m Z <br /> Page 1 of 4 0 <br /> Burnett Count, NV 1 Land Use Application —Rev 1/2016 <br /> 3 <br /> m <br /> a <br /> m <br />