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LAND USE PERMIT APPLICATION— Burnett County. WI , <br /> y .e <br /> Permit Fees: 7 i <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwellin /Princi al BuiMBuIldin $200 <br /> $200 O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Bui $200 m <br /> Commercial/Industrial Building $300 Addition to Commercial/industrial $200Accesso Structure/Addition to Acc.Structure $150 Bunkhouse $250Accesso Structure-Commercial Cl&11 $200 Addition to Accesso Structure-C $200 <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(ly)) $350 c <br /> Camping Unit $100 Fillin Gradi $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $loo <br /> o <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 /> 'o <br /> Applicant Complete All Sections Below This Line c . <br /> �O i Ny n/ 5�•��9Ff�,2 <br /> Applicant's Name: pct ',,G �,�,� <br /> Applicant's Mailing Address: �70 / /,Q6/v�l L 4{�� 5' C I1&6 : bX /0 S�V�L <br /> / City State Zip , <br /> Applicant's Telephone Number: <br /> — e <br /> Applicant's Email: �'q�✓ScA✓� �(JpIQ 1 L , CO✓✓l o <br /> m <br /> B <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑LetterPhone Email o <br /> Legal Description: PC G0✓ LOT ell,Q&:E -t4ryr #3576.7 3 <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR <br /> y <br /> Gov't Lot#: OR 1/4 1/4 710 £ l <br /> Section#: S/3 Town#:T tlD N Range#: R l 7 W Town of. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* l 3 <br /> Parcel#(24 digits): D�—y3 6—�— yy-/ �- vs=U)y oa 10 Do <br /> Tax ID#(1-5 digits): <br /> Property Site Address#: 4a 1// / /� <br /> Road Name: Z1- - g lass G/Q!CC & City: ,./lqxull y SIV <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee RecARS000 <br /> ❑Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑Commercial Building <br /> ❑Single Family Addition ❑ Multi-Family Addition )(Deck/Patio ❑Commercial Addition 6 <br /> ❑Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑Commercial Acc.Structure m <br /> N <br /> ❑ Permit Extension ❑ Gaiebo—WI Sttat�59.692(ly) ❑Camping Unit ❑Commercial Acc.Addition z <br /> 2 CD <br /> Proposed Structure/Addition Use: a <br /> 7 (Home/Cabin,'Commercial Business;Bedroom;Deck;etc.) Z C <br /> ON M <br /> Building Contractor: —f <br /> Anticipated Start Date: .11(Ly 10 c <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> in <br />