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LAND USE PERMIT APPLICATION— Burnett County, WI `° r <br /> a � C <br /> - ro <br /> Permit Fees: °a U <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwell in rinci 1 Building-Single Family $200 O _ <br /> Dwelling/Principal Building-Multi-Family $300 Addition to DweHingfPrincipal Building-Multi-Famil $200 9 . <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 i <br /> Accessory Structure/Addition to Acc.Structure $150 Runkhousc $250 1 <br /> 0 <br /> Accessory Structure-Commercial Cl&11) $200 Addition to Accessory Structure-Commercial Cl&Il) $200 e <br /> Deck/Stairs/Patios $125 Gazebo Stat 59.69 lv)) 5350 0 <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 <br /> o <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. y <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 /> Applicant Complete All'Sections Below This Line <br /> / l o <br /> Applicant's Name: �Q/1*9 e <br /> Applicant's Mailing Address: 1057 i:�r�r.✓e�� j f �f�e,u< <✓t'JfJI r�(�7 <br /> City State Zip ni b <br /> .Applicant's Telephone Number: <br /> Applicant's Email: h)�A fleeICWAv, 14?, tr'/'Z tO <br /> w <br /> If staff bas a question about this application how do you prefer to be contacted? Check one below. <br /> ]Letter 4Aj <br /> -"Phone DEmail b <br /> o <br /> Legal Description: ' <br /> o lJ <br /> Lot#: CSM Vol. Pg. OR ,�• 1 <br /> Lot#: Block#: Subdivision Name: OR „ pC <br /> Gov't Lot#: OR 1/4 1/4 I�JJ F JL` <br /> Section#: Town#: N Range#: W Town of: <br /> *Anach additional e i needed or len thv description OR attach a copy o the deed OR attach tax system property page. <br /> * W y <br /> Pall f � 8 P p f Y P p p R <br /> i <br /> Parcel#(24 digits): <br /> Tax 1D it(1-5 digits): <br /> z <br /> Property Site Address <br /> Road Namc: <br /> TYPE OF PERMTT(5): Check appropriate box/boxes Fee Rec15D Q-0 <br /> ❑Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filing/Grading ❑ Commercial Building ~ <br /> ❑Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 2 <br /> ❑Stairsc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure C <br /> LlPermit Extension Gazebo—WI Stat 59.692(iv) ❑ Camping Unit ❑Commercial Acc. Addition Z o <br /> M <br /> 0 <br /> Proposed Structure/Addition Use: Af-le 1,4 c M <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ap � <br /> Building Contractor: Ct> smart 1!,&h S jr <br /> Anticipated Start Date: f/ Z S m r <br /> Page 1 of 4 so <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br />