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LAND USE PERMIT APPLICATION—Burnett County, WI a g b <br /> Permit Fees z l; vt <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 a <br /> Oj <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwelling/Principal Building-Multi-Famil $200 <br /> CommerciaUIndustrial Building $300 Addition to Commercial/Industrial Building $200 O <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 t o <br /> Accessory Structure-Commercial CI &11) $200 Addition to Accessory Structure-Commercial(Cl &[l) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(Iv)) $350 0 <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only l Allowed $100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. v <br /> w <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 /> ro <br /> ro <br /> Applicant Complete All Sections Below This Line o . <br /> CZ � � ` z <br /> Applicant's Name: Il/ytl` � Iv� <br /> AI� .ld1� �] if 0 <br /> Applicant's Mailing Address: /� )S� Sit-re' �ui,'1711 W— SN'�� (� d <br /> AX <br /> CiqJ State Zip b <br /> 600- <br /> U z <br /> Applicant's Telephone Number. �1S ' V)R <br /> r 1 <br /> Applicant's Email: p <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> RL.etter TRPhone ❑Email <br /> o <br /> Legal Description: <br /> Lot#: CSM Vol. Pg. OR o <br /> N <br /> 1 <br /> Lot#: Block#: Subdivision Name: OR F, <br /> Gov't Lot#: OR Sw 1/4 AIC1/4 <br /> — g <br /> Section#:_ Town#: � N Range#:___0 W Town of. Woox K; <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* -j <br /> Uj <br /> I <br /> Parcel#(24 digits): <br /> z <br /> Tax ID#(1-5 digits): <br /> Property Site Address#:Jv7J L _ y <br /> Road Name: �ry_k RA City: Gru.�4S�v^ <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec <br /> Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building z <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition N <br /> `o <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc.Structure N <br /> L3Permit Extension E3Gazebo-WI Stat 59.692(ly) LlCamping Unit L3Commercial Acc.Addition z C <br /> n <br /> Proposed Structure/AdditionUse: C Z C <br /> 1 (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) •:yam <br /> Building Contractor: S D0 r'I S M0_1)S Qc"t�Lf� ddJJ <br /> -�• V <br /> Anticipated Start Date: Jy ca <br /> m �. � �b•"l i! <br /> Page 1 of 4 0 _ <br /> Burnett County,WI Land Use Application—Rev 4/20151 <br /> m <br /> F <br /> T <br />