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LAND USE PERMIT APPLICATION —Burnett County, WI <br /> 6 <br /> r q <br /> Permit Fees: - <br /> Dwellin rinci al Building-Single Family $300 Addition to Dwelling/Principal Building-Si IcFamily 5200 I(Sj <br /> DwellingtPrincipid Building-Multi-Family $300 Addition to Dwell in rinci Building-Multi-Family 5200 fV� <br /> CommercialQndustrial Building 5300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Ace.Structure 5150 Bunkhouse S250 f <br /> Accessory Structure-Commercial Cl&11 5200 Addition to Accessory Structure-Commercial Cl&11 $200 <br /> Deck/StairdPatios 1 $125 Gazebo WI Stat 59.692(l v 5350 a � <br /> Camping Unit I SI00 Filling/Grading $150 C <br /> Permit Extension Valid for one year-Only 1 Allowed $100 , <br /> *NOTE:After-the-fad(when no permit is obtained prior to construction)is three times the normal fee. v <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. 5 <br /> Applicant Complete All Sections Below This Line <br /> ` c <br /> Applicant's Name: 4exr r;e - - <br /> Applicant's Mailing Address:—2k--,3 [7s'n.�e S 1��"` Lr � `�� /�N -ss©Ny <br /> _� y- <br /> City State Zip � .e <br /> _ z <br /> Applicant's Telephone Number:_17S.2-^ 8y 3 `- 3%Ic i <br /> e <br /> Applicant's Email: t710 Me /0 tg 71M6., �• tC�� -� o <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. I <br /> t <br /> OLetter [Phone ❑Email w *° <br /> Legal Description: ------ v� <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 114 114 a <br /> Section#: Town#: N Range A;-W Town of: <br /> *Attach additional page if needed for lengthy description OR attach n copy of the deed OR attach tux system propertypage. <br /> _I <br /> 1 <br /> Parcel#(24 digits): <br /> n z <br /> Tax ID#(1-5 digits): _ a <br /> -Property Site Address#_,r 2 l __- _ _ -`-- - - -- -- - <br /> Road Name:_A"-c.�oe= G-a City: lea •►IT �Scm 1 <br /> f <br /> TYPE OF PERMrP(S): Chedt appropriate box/boxes Fee Rec: <br /> O Single Family Dwelling O Multi-Family Dwelling ❑Filling/Grading O Commercial Building z <br /> U <br /> O Single Family Addition O Multi-Family Addition ❑ Deck/Patio ❑Commercial Addition o <br /> ❑Stairs O Acc.Structure(Non-bunkhouse) O Bunkhouse ❑Commercial Acc.Structure ti <br /> O Permit Extension L3 Gazebo-WI Stat 59.692(iv) Camping Unit ❑Commercial Acc. Addition ? to Q <br /> C <br /> Proposed Structure/Addition Use: Lo ��„ Z D B u u <br /> (H a/Cabim Commercfo!8vsiness;Bedroom;Deck;etc f ; N 50 <br /> zo- <br /> � z 1 <br /> Building Contractor:_. <br /> ated Start Date: IS` J� <br /> +n O <br /> Anticipated o <br /> p —. C <br /> Page 1 of 4 ® Z <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br />