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LAND USE PERMIT APPLICATION- Burnett County WI ry <br /> < � b <br /> .r <br /> Permit Fees: <br /> Dwellin /Princi al Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 b �N <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 Accessory Structure or Bunkhouse $250 <br /> Accessory Structure-Commercial(CI&Il) $200 Addition to Accessory Structure-Commercial Cl&Il) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 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. <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 /> z <br /> Applicant's Name: La r✓� L2wron <br /> Applicant's Mailing Address: g9 N f= er P° j <br /> City State Zip o <br /> // z <br /> Applicant's Telephone Number: (p�oZ -Gr 3 b - �6 b -7 o c <br /> F d <br /> f. <br /> Applicant's Email: f r l .r, , (A7 4 o f rrta i <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter ElPhone mail <br /> N � t <br /> Legal Description: y' o"o 6-- ir.<t 3 � <br /> Lot#: CSM Vol. Pg. OR d <br /> y <br /> R <br /> Lot#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1 4 <br /> Section 0 Town#: N Range#: W Town of: I i <br /> *Attach additional page ifneeded for lengthy description OR attach a copy of the deed. <br /> Parcel#(24 digits): 0'7^va9 -e2 - `1foo- -oo3 a/lOav r <br /> Tax ID#(1-5 digits): <br /> � � I <br /> Property Site Address#: <br /> Road Name: Cor, . 4, R City: $ t v <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: <br /> LJSingle Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading LJCommercial Building ' <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs XACc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition <br /> Proposed Structure/Addition Use: w f, 43kt/e/,`� arm <br /> (Home/Cabin;Commerci t Business;Bedroom:Deck.etc.) <br /> N Z <br /> e%�' i <br /> a <br /> Building Contractor: S <br /> r•+ <br /> // ` N � <br /> Anticipated Start Date: '7 - /y—/s' 2Z0 <br /> CS <br /> Page 1 of 4 3 C <br /> Burnett County,WI Land Use Application—Rev 3/2015 <br />