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LAND USE PERMIT APPLICATION— Burnett County, WI r <br /> M <br /> Permit Fees: <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Famil $200 O <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwellin /Princi al Buildin -Multi-Famil $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 O <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 i a <br /> \v <br /> Accessory Structure-Commercial Cl&Il $200 Addition to Accessory Structure-Commercial C1&Il) $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(ly $350 0 <br /> Camping Unit $100 Fillin /Gradin $150 - <br /> t, <br /> Permit Extension Valid for one year-Only 1.4llowed $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 andfees. <br /> w <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls q <br /> 'a <br /> x <br /> Applicant Complete All Sections Below This Line <br /> Applicant's Name: 50 <br /> dTe r1 1`t ISL 1 (�LL--__,, � <br /> Applicant's Mailing Address: 1 3 S ILrY,�f�1 D r i V 2 shXe le t/ /11 l ss/� <br /> City State Zip r) a <br /> / tip p ^ z <br /> Applicant's Telephone Number: (o Sl �l 1 6CJ1 Q �- <br /> 'c <br /> Applicant's Email: �( • hiw9�� ClGtt�(Jt.l ('.7 O <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> •o <br /> ❑Letter 'Phone PEntail °Q <br /> Legal Description: to I-V2 esm V P 39 (7iv (1 <br /> 1 <br /> Lot#: z CSM Vol. 9. 39 OR U'I <br /> i <br /> Lot#: Block#: Subdivision Name: OR m <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: 1 <br /> �*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* a 1 <br /> Parcel#(24 digits): O 11 ' Z '40 -1 S-Z`I'S 05 00-3 017e no <br /> Tax ID#(1-5 digits): �� t0o 2 <br /> G22 ti z <br /> Property Site Address#: ZO ✓J_ T r <br /> Road Name: &rv►e p 4A4:e- City: <br /> F <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: I�e <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building x <br /> 6; <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition N <br /> 0 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> N <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692 lv 0 <br /> ( ) Camping Unit ❑ Commercial Acc. Addition <br /> n <br /> N D <br /> Proposed Structure/Addition Use: W <br /> (Home/Cabin;Commercial Business;Bedroom;Deck:etc.) � C <br /> � n <br /> Building Contractor: O Z _ <br /> Anticipated Start Date: p ,'Z � I n <br /> Page 1 of 4 0Z O o <br /> Burnett County,WI Land Use Application—Rev 1/2016 <br /> Z !� <br /> x <br />