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LAND USE PERMIT APPLICATION — Burnett Count, W! 5-- <br /> Permit <br /> Permit Fees: a Iv,�` <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 0 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 g WWW <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 v O <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 1 OQ E <br /> 1 <br /> Accessory Structure-Commercial Cl &11) $200 Addition to Accessory Structure-Commercial CI &R) $200 <br /> Deck/Stairs/Patios 1 $125 1 Gazebo WI Stat 59.692(l v)) $350 0 1 <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. to <br /> m <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 /> Applicant Complete All Sections Below This Line <br /> f <br /> Applicant's Name: ° <br /> Q ala l//!! <br /> Applicant's Mailing Address: p? <br /> City State Zip <br /> / � z <br /> Applicant's Telephone Number: 7� �[� � �3 o Or <br /> Applicant's Email: o <br /> d <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ]Letter Phone ❑Email 0 00 <br /> Legal Description: ts- <br /> m' <br /> Lot#: CSM Vol. Pg. OR <br /> N <br /> I <br /> Lot#: Block#: Subdivision Name: OR <br /> n <br /> I <br /> Gov't Lot#: OR Iv 1/4��1/4a7 �1 I � £ <br /> Section#: _Town#:�N Range#:_10—W Town of: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits):Q7-L -oZ-l�(}��p ��-�o�- J(}C� 'D'D <br /> x <br /> Tax ID#(1-5 digits): 13 {3 I r' z <br /> Property Site Ad ess#:2Qa%2 y <br /> Road Name:TCity: <br /> -Pjalv <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec-0 <br /> Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> d <br /> ❑ Stairs 13 Acc. Structure(Non bunkhouse) El Bunkhouse 11 Commercial Acc. Structure o C <br /> L3 Permit Extension Gazebo-W{ El Stat 59.692(ly) Camping Unit <br /> , L] CommercialAcc. Addition z <br /> Proposed Structure/Addition Use: B.ee{ ,peD/r� f IC3 � /Jc1 171`3Y>7S/ y Z B u u <br /> (Home/Cabin:Comm'ercm' l Business;Bedroom:Deck:etc.) <br /> Building Contractor. /7C i t%�a tt s 20 t� <br /> Anticipated Start Date: � �, /� s�6/15� n Z o <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application—Rev 4/2015 > <br /> 3 <br /> o <br /> x <br /> m <br /> a <br /> M <br />