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LAND USE PERMIT APPLICATION—Burnett County, WI a b <br /> y w y <br /> Permit Fees: <br /> a <br /> DwellingfPrincipal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial C l &11) $200 Addition to Accessory Structure-Commercial C I &11) $200 <br /> Deck/Stairs/Patios $125 Gazebo WlStat 59.692(lv)) $350 0 <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. v <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 /> v <br /> Applicant Complete All Sections Below This Line <br /> z <br /> P <br /> Applicant's Name: DAW Sd-fit j <br /> Applicant's Mailing Address: Py//tt. si-V <br /> CCyy,, City State Zip :2 <br /> Applicant's Telephone Number: 1- a" -s2g1 o y <br /> � <br /> c <br /> m <br /> Applicant's Email: v <br /> io <br /> If staff has a question about this application how do yvou prefer to be contacted? Check one below. <br /> W <br /> ❑Letter EiPhone ❑Email c t <br /> Legal Description: lca Xa.q Skel Q <br /> Lot#: CSM Vol.. Pg. .222- OR v <br /> 3. <br /> Lot#: Block#: Subdivision Name: OR s <br /> Gov't Lot#: OR _1/4 50J 1/4 �- <br /> Section#:_,3d Town#: '>/a N Range#: /t W Town o£ O aL <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* I <br /> Parcel#(24 digits): 07.010 -2-1/6- It - aS-,3 of '040 - 01110 D <br /> / � z <br /> Tax ID#(1-5 digits): <br /> Property Site Address#: k1 11 wide J 1-44 Q�• y <br /> Road Name: c O N t f L&4 O D. City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rei rM <br /> ❑ Single Family Dwelling Ll Multi-Family Dwelling ❑ Filling/Grading 13 Commercial Building <br /> ❑ Single Family Addition ❑ JNulti-Family Addition ❑ Deck/Patio El Commercial Addition <br /> m <br /> ❑ Stairs Acc. Structure(Non-bunkhouse) Ll Bunkhouse Ll Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition z W <br /> p 5{,t,� n <br /> y <br /> Pro osed Structure/Addition Use: '' Z <br /> (Home/Cabin;Commercial Business:Bedroom:Deck;etc.) <br /> � <br /> ����f, I r--� <br /> Building Contractor: T A J . )w l t Ay /4111 Ng r �_ B® <br /> Anticipated Start Date: m C <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> M <br /> m <br />