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LAND USE PERMIT APPLICATION— Burnett County, WI00 <br /> a 3 <br /> n <br /> y Nr <br /> Permit Fees: s <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwellin rinci al Building-Multi-Famih $200 _C <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 �— <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse250 _ & <br /> Accessory Structure-Commercial C1 &11) $200 Addition to Accessory Structure-Commercial(Cl &11) $200 ^ <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(lv)) $350 c CO <br /> < t <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only I Allowed) $100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. 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. JNq <br /> �u <br /> rn <br /> Applicant Complete All Sections Below This Line � � <br /> A1200�d ! r � f tl�f� oAPPlicant s Name: �IG 1,,,/'n <br /> Applicant's Mailing Address: 6<�� -7� LCI t I I� ��1 +`d ti f� <br /> City State Zip rA <br /> I (�5� -u G0� <br /> Applicant's Telephone Number: � o y Cy <br /> `m C <br /> Applicant's Email: , t- - ed ,XnjL a)AOQ�� o hooi con o <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter []Phone .mail <br /> Legal Description: C S 2r ' <br /> Lot#: CSM Vol. Pg. o OR d <br /> Lot#: Block#: Subdivision Name: OR = „ <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: C)(D,\�,ti a(l <br /> *Attach additional a e i needed or lengthy description OR attach a co o the deed OR attach tax system ro er a e.* y l <br /> P g .f f g Y�1 IIP / - —7 PY f �j t� Y P P tYP g <br /> Parcel#(24digits): 61 —0d0 -9— q0 ' 6--0 —5 S60—NU000 <br /> Tax ID#(1-5 digits): n z <br /> Property Site Address#: ` , ' <br /> Road Name: L(jtS �1 L\ �i(l✓ UL\U�r pL� City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: Z)S0 <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> N <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> 0 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) '1116unkhouse ❑ Commercial Acc. Structure Q <br /> C3 Permit Extension E3 Gazebo—WI Stat 59.692(Sv) E3 Camping Unit ❑ Commercial Acc.Addition z C <br /> c� o �,t 6 <br /> 61 y ( 1 <br /> Proposed Structure/Addition Use: C b� v 1�t �z - <br /> (Home/Cabin; ommercial usiness; edroom:Deck;etc.) <br /> Building Contractor: Ev—O r- <br /> Anticipated Start Date: <br /> Page 1 of 4 C <br /> Burnett County,WI Land Use Application — Rev 4/2015 _ y <br /> A <br /> m <br />