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LAND USE PERMIT APPLICATION - Burnett County, WI a ro <br /> Permit Fees: � to <br /> Dwell ing/Principal 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 1 <br /> Accessory Structure-Commercial(CIA 11) $200 Addition to Accessory Structure-Commercial(Cl &11) $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(l v)) $350 c � <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 c <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. <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. 2 <br /> V <br /> Applicant Compl to All Sections Below This Line a <br /> to o <br /> Applicant's Name: /-/J <br /> Applicant's Mailing Address: f/ g v ' /(p �64 �� � ( (yl SYM <br /> Q pCity State zip <br /> Applicant's Telephone Number: a7 3 0 <br /> Applicant's Email: <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. v 1 <br /> ❑Letter Phone ❑Email N <br /> a t <br /> Legal Description: a' <br /> Lot#:_ CSM Vol. g. '4 OR <br /> a. <br /> Lot#: Block#: Subdivision Name: ORJj <br /> r„ <br /> Gov't Lot#: OR 1/4 1/4 Ip 1 £ 1 <br /> Section#: Z Town#:_,3_9_N Range#:--/-&-W Town of: '-Z(Cn ( Nwl <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertyPage. <br /> Parcel#(24 digits): 07-0d -d,-3q-Z& -r}s-s os-oo y-v�f�ooy <br /> t� <br /> Tax ID#(1-5 digits): 7S g 01% Z <br /> N <br /> m <br /> Property Site Address#: n CP ` I <br /> Road Name: P`, W4- 2t� City: W �e b_> e r- <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:Lct_,U <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition N <br /> ❑ Stairs cc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure � <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition C <br /> z <br /> p Shed [yxIS' z � <br /> Proposed Structure/Addition Use: n <br /> Shed <br /> Cabin:Commercial Business;Bedroom;Deck:etc.) <br /> Building Contractor: 90 <br /> CD <br /> U u u <br /> Anticipated Start Date: C �n <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application—Rev 4/2015 ; -C <br /> 3 <br /> x <br /> M <br /> z <br /> m <br />