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LAND USE PERMIT APPLICATION— Burnett County, WI a _ <br /> N ^ <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 d S <br /> Dwell in Princi al Building-Multi-Family $300 Addition to Dwell in Princi al Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 i O <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial C1 &It) $200 Addition to Accessory Structure-Commercial CI &II $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(l v)) $350 <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Onl 1 Allowed $100 <br /> r <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. a <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. �' I <br /> */terns not listed above will be treated as accessory structures,such as:pergolas, landscaping, retaining walls. <br /> Applicant Complete All Sections Below This Line <br /> JJ z <br /> Applicant's Name: h Or ey-I ac-•-J f411 S <br /> Applicant's Mailing Address:�;2 3 531 Shu#le <br /> City State Zip t, <br /> Applicant's Telephone Numb Y GQ�� ��- to 7v--_2N� <br /> Applicant's Email: o <br /> d <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter Phone ❑Email <br /> o <br /> Legal Description: ' <br /> Lot#: CSM Vol. Pg. OR <br /> 3. <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR i 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: alc S Q ) <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> W <br /> - 1 <br /> Parcel#(24 digits): ` <br /> Z <br /> Tax ID#(1-5 digits): 2 <br /> Property Site Address#:— 93/ y <br /> Road Name: �h K 1( /0— /,JD/4h City: /}�e`l (/✓ <br /> E <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:1 .* <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ,milling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition a <br /> ❑ Stairs Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> LlPermit Extension LlGazebo–WI Stat 59.692(ly) LJCamping Unit ❑ Commercial Acc.Addition z C 0 <br /> C <br /> Proposed Structure/Addition Use: y <br /> H <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor, I"G C #101, i(/ <br /> i-+ I�SrJ <br /> ^ 0 o <br /> Anticipated Start Date: <br /> Page 1 of 4 o Z <br /> Burnett County, WI Land Use Application—Rev 4/2015 �� <br />