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Cn <br /> LAND USE PERMIT APPLICATION— Burnett County, WI <br /> a — b <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to DwellinglPrincipal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to DwellinglPrincipal Building-Multi-Family $200 <br /> Commercial/IndusMal Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Accessory Structure or Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &Il <br /> $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 �' 1 <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 0 <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. 2 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping, retaining walls. <br /> 'v <br /> m <br /> Applicant Complete All Sections Below This Line <br /> R z <br /> Applicant's Name: AF� <br /> Applicant's Mailing Address: An e— ure— /40V <br /> City State zip <br /> t—, <br /> PPTelephonesI' ! D <br /> Applicant's Numb <br /> Applicant's Email: IR C-04V�� �� 1 , ro /Y1 r d <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter ,Phone ❑Email N 0°Cq 1 <br /> Legal Description: 1 <br /> Lot#: ✓ CSM Vol. Pg. OR C <br /> Lot#: Block#: Subdivision Name: OR r„ <br /> Gov't Lot#: OR 1/4 1/4 f <br /> 7 <br /> Section#: Town#: N Range#: W Town of- <br /> f <br /> f: <br /> fneededfor lengthy description OR attach a copy of the de <br /> ed OR attach tax system property page.additional age i <br /> Parcel#(24 digits): <br /> r x <br /> Tax ID#(1-5 digits): 01<;Zq 6. z <br /> M y � <br /> Property Site Address#: A9 <br /> ! !:9 /+ fl^e fry L C•c-G h ' <br /> Road Name: e1'y c, Ct 1 G �� City: <br /> F <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee R=�11 <br /> eV'Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building s <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> m <br /> ❑ Stairs Ll Acc. Structure(Non-bunkhouse) L3 Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(Sv) ❑ Camping Unit ❑ Commercial Acc.Addition Z <br /> OD <br /> Proposed Structure/Addition Use: /y.,e iV Z <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 0 <br /> g Self °z Z- o <br /> Building Contractor: 2 0 N <br /> Anticipated Start Date: Xe; A 0 - cn <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application—Rev 3/2015 > �� <br /> 3 <br /> v <br /> x <br /> m <br /> A <br /> m <br />