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LAND USE PERMIT APPLICATION — Burnett Countya <br /> , WI r <br /> C <br /> Permit Fees: ;' ut <br /> a <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwelling/Principal Building-Sin le Family $200 � O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaVlndustrial Building $200 v p <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(Cl &Il $200 Addition to Accessory Structure-Commercial Cl &Il $200 rn ` <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(l v)) $350 <br /> Camping Unit $100 Filling/Grading $150 <' <br /> Permit Extension Valid for one year-Only 1 Allowed $100 <br /> 0 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. i <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 /> m <br /> Applicant Complete All Sections Below This Line . <br /> � � o <br /> Applicant's Name: m t& <br /> Applicant's Mailing Address: <br /> City State zip <br /> PPTelephone <br /> Applicant's s Number: <br /> c <br /> //�� m <br /> Applicant's Email: t% A/ 7R Y /A tfd/ (A-W 70 /2)( Zee- . AIL v <br /> d <br /> iP <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter DdPhone ❑Email N <br /> w <br /> 0 <br /> Legal Description: 5 <br /> as <br /> Lot#: CSM Vol. Pg. OR t7 <br /> 1 <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#:-:E—ORToX1/4 1/ £ <br /> Section#: � Town#:�N Range#: W Town of.-,C <br /> *Attach additional page if needed`or lengthy description OR attach a copy of the deed OR attach tar system propertyPage.* a 1 <br /> Parcel#(24 digits): <br /> z <br /> Tax ID#(1-5 digits): aq4 <br /> Property Site Address#: 30 c27 d <br /> Road Name: /9A K 1/4 It City:((�L gs 76-:7 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:Lazo <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building /fir <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition z <br /> N <br /> Proposed Structure/Addition Use: Q �' L > C <br /> (Home/Cabin:Commercial Business; oom;D k;etc.) 'n <br /> r <br /> Building Contractor: aO✓)') Cr Q LdA/6r R ego <br /> Anticipated Start Date: /,7r) /S O <br /> Page 1 of 4 o Z <br /> Burnett County, WI Land Use Application—Rev 4/2015 , <br /> X <br /> m <br /> a <br /> m <br />