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LAND USE PERMIT APPLICATION— Burnett County, WI a _ <br /> Permit Fees: - t <br /> a IJP <br /> Dwelling/Principal Building-Single Famil $300 Addition to DwellinglPrincipal Building-Single Fa 200 I�! <br /> Dwellin rinci al Building-Multi-Famil $300 Addition to Dwellin rinci al Building-Multi-Famil $200 <br /> CommerciaVlndustrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial CI &II $200 Addition to Accessory Structure-Commercial CI &Il $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(lv)) $350 c <br /> Camping Unit $100 Filling/Grading $150 �' T <br /> Permit Extension Valid for one year-only I Allowed $100 S <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. ti <br /> d <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. 1P <br /> o <br /> m <br /> Applicant Complete All Sections Below This Line <br /> Applicant's Name._ ►�/ Q �n�,y t 1 1 q �� o <br /> Applicant's Mailing Address: <br /> + City State -Zib � <br /> Applicant's Telephone Number: o 'Q * <br /> r <br /> Applicant's Email: o d <br /> m <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> t <br /> []Letter Phone MEmail N <br /> RS <br /> Legal Description: p <br /> Lot#: l CSM Vol. Pg. OR <br /> Lot#: Block#�^4a Subdivision Name: OR " m <br /> Gov't Lot#: OR 1/4 1/4 F i <br /> Section#: t` ) Town#:�N Range#:-L�W Town of: �/ 1\�!Q(� ��CC77 <br /> *Attach additional page i needed or lengthy description OR attach a co o the deed OR attach tax system property page. <br /> * 1 <br /> Pg .I .f gY P copy Y P P tYPg <br /> Parcel#(24 digits): C e010 460 Q M <br /> Tax ID#(1-5 digits): d <br /> Property Site Address#: /1 N <br /> Road Name: C, City: 4 IY <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec�,CD <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> 'o <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> ° <br /> ElPermit Extension E3 Gazebo–WI Stat 59.692(ly) ❑ zCamping Unit ❑ Commercial Acc.Addition <br /> II " C <br /> Proposed Structure/Addition Use: LNhQ,• 1&0 me � <br /> �i <br /> (Home/Cabin;Commercial Business:Bedroom;Deck:etc.) o N Z m <br /> ���� �a c��a �� ��� r <br /> Building Contractor: , K Z �+ <br /> Anticipated Start Date: t/ "�1 m G o <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> 3 <br /> m <br /> a <br /> m <br />