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LAND USE PERMIT APPLICATION —Burnett County, WI a _ b <br /> rn Hr <br /> Permit Fees: g to <br /> a <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwellin rind al Building-Sin le Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaUIndustrial Building $200 O <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 1 E <br /> 0 <br /> Accessory Structure-Commercial Cl &Il) $200 Addition to Accessory Structure-Commercial CI &11 $200 1 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(lv)) $350 c <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. v <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 /> a <br /> Applicant Complete All Sections Below This Line <br /> Applicant's Name: dr, <br /> Applicant's Mailing Address: VC LP�7 Lox- s'- a <br /> CityState zip vn b <br /> Applicant's TelephoneNumber: q Z 1 — l 000 o y d <br /> c <br /> 1 n. <br /> Applicant's Email: Y-IrL�A�I �1�� YYLAI I C� � U <br /> io <br /> If staff has a question about this application how do you prefer to be yontactS Check one below. I <br /> ❑Letter ❑Phone Email o °q <br /> Legal Description: IN 1 <br /> Lot#: CSM Vol. Pg. d <br /> y <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 0 <br /> E <br /> Section#: Town#: N Range#: W Town of: <br /> *Attach additional age if neededfor lengthy description OR attach a copy of the deed OR attach tax system property Page.* y <br /> Parcel#(24 digits): <br /> a <br /> z <br /> Tax ID#(1-5 digits): n� � <br /> Property Site Addres #: <br /> Road Name:_AD150y) City: <br /> F <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:.� at <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> `v <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition <br /> n C <br /> V <br /> Proposed Structure/Addition Use: r\P —ff>A(-ti0 <br /> (Dome abin;CommercialBusiness;Bedroom;Deck;etc.) Z <br /> �N <br /> Building Contractor: t4 Vl i <br /> As. <Z (N�l] <br /> AZn <br /> Anticipated Start Date: Z (�{�F m o C o <br /> Page 1 of 4 o Z [ <br /> Burnett County, WI Land Use Application—Rev 4/2015 <br /> b <br /> m <br /> a <br /> m <br />