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LAND USE PERMIT APPLICATION— Burnett COunty, WI g <br /> a• - b <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 d <br /> Dwelling/Principal Building-Multi-Family $300 Addition to <br /> Dwelling!Princial Buildin -Multi-Famil $200 11 <br /> Commercial/Industrial Ruilding $300 Addition to Commercial/Industrial Building $200 ) <br /> O <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 ' <br /> Accessory Structure-Commercial(Cl &II) $200 Addition to Accessory Structure-Commercial(Cl &It) $200 <br /> a _ <br /> Deek/Stairs/Patios $125 Gazebo(WI Stat 54.692(lv)) $350 C <br /> Camping Unit $100 Fillip Gradin $150 <br /> r ^- <br /> Permit Extension(Valid for one year-Only 1 Allowed) $100 ° QI) <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. v Q� \ <br /> *Communication Towers&Signs require a different application Jorm,see corresponding application andJees. V <br /> w <br /> *hems not listed ahove will he treated as accessory structures,such as:pergolas, landscaping, retaining walls. <br /> v <br /> Alipl# e1itC©2rrp( t( leeti $elaIt Llrib a . <br /> Z <br /> Char Ie s Pe-dew's o,J <br /> Applicant's Name: pp �j/ p '\ <br /> Applicant's Mailing Address: 86 l M,' >o ey t/'G, t�1 r'C l e ba,) 'Aj <br /> City State Zip <br /> / 6v07 <br /> Applicant's Telephone Number: �(�3 o :^ <br /> C <br /> Applicant's Email: �� (� (�tGU9 , �tJ ►'� 1 p <br /> J" G <br /> A <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter ®Phone R]Email N <br /> Legal Description: <br /> Lot#: yZ CSM Vol. Pg. OR o <br /> Lot#: Block#: Subdivision Name: OR „ <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: <br /> 'Attach additional a e.il'needed br len tiw description OR attach a copy o the deed OR attach tax system propertv page.* y <br /> Parcel#(24 digits): r, <br /> m <br /> Tax ID#(1-5 digits): z <br /> Property Site Address#: <br /> �9 69 <br /> Road Name: A^ t V uti t r City: 1 �/ <br /> TYPE OF PERMIT(5): Check appropriate box/boxes Fee Rec: Ie_ <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building , <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs 5� Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(iv) ❑ Camping Unit ❑ Commercial Acc. Addition C <br /> mz <br /> Proposed Structure/AdditionUse: gcura-o'e Z CD <br /> (Home/ abin Cam eret call B,*esss;�Be�droom:Deck;etc.) <br /> Building Contractor: Q(o4} <br /> Q <br /> lli, <br /> ry <br /> b&; <br /> Anticipated Start Date: Z cr <br /> Page i of 4 ig` <br /> Burnett County, WI Land Use Application—Rev 4/2015 4` � <br />