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LAND USE PERMIT APPLICATION — Burnett County, WI r <br /> U ~ 1 <br /> Permit Fees: <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwellin Princi al Building-Single Family $200 o t 7 F <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 1 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse S250 1 <br /> Accessory Structure-Commercial(CI &11) $200 Addition to Accessory Structure-Commercial(CI &11) S200 to g <br /> Deck/Stairs/Patios 1 $125 1 Gazebo(WI Stat 59.692(lv)) 1 $350 0 1 <br /> Camping Unit 100 Filling/Grading Filling/Grading5150 <br /> Permit Extension(Valid for one year-Only I Allowed) 1 $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. y� <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping, retaining walls. <br /> ro <br /> Z <br /> Applicant's Name: , <br /> Applicant's Mailing Address: Uri1 ia <br /> City State Zip ro <br /> / 42�.t t z <br /> Applicant's Telephone NumberE�j J 7 ' ;� %��[7 Sy �%' `I�0 — o_ y <br /> Applicant's Email S I- "G(e_ d <br /> w <br /> rn <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ro <br /> ,Letter Phone ❑Email o j <br /> Legal Description:Lf a CT q? Ah /5 sw i SS <br /> Lot#: CSM Vol. `f Pg. OR q <br /> N <br /> Lot#: _Block#: Subdivision Name: OR s „ <br /> Gov't Lot#: OR 1/4 1/4 I <br /> Section#: Town#: N Range#: W Town of: s w;i SSS <br /> *Attach additional page iJ neededIor lengthy description OR attach a copy q1 the deed OR attach tax system property,page.* <br /> (01-0_�L�' � - yI 1-5- ;?6`5 -05- (),-)-3- r31oC-1,30, <br /> Parcel#(24 digits): 0-3 5 a vA (4 — O 3 — rr, <br /> `� 155'N z <br /> Tax ID#(1-5 digits): <br /> N i <br /> Property Site Address#: <br /> Road Name: l tJ L u` / Nl=�o WL_,1? City:. — l <br /> TYPE OF PERMIT(5): Check appropriate box/boxes Fee Rec: <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) X.Camping Unit ❑ Commercial Acc. Addition <br /> n <br /> Proposed Structure/Addition Use: —0 <br /> (Home/Cabin:Commercial Business:Bedroom,Deck:etc.) _ ;;o <br /> i-Z <br /> Building Contractor: <br /> N <br /> O <br /> Anticipated Start Date: <br /> Page 1 of 4 U <br /> Burnett County,WI Land Use Application —Rev 4/2015 <br />