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LAND USE PERMIT APPLICATION—Burnett County, WI g <br /> Permit Fees: <br /> n U <br /> Dwelling/Principal Bial -Sinvjc Family 5300 Addition to Dwell' Buil -Single Family SM <br /> Dwell' c' Building-Multi-Family $306 Addition to DwamWftnxVW Building-Multi-F32M <br /> Commercial4ndustrial Building $300 Addition to ComnxrciaVlnduttrisl Building SIN <br /> Accessory StructurelAddition to Acc.Structure $150 Bunkhouse 5250 r <br /> Accessory Structure-Commercial Cl&I I SM Addition to Accessory Stnrchuc-Comrrcrciat(Cl&It 5260 <br /> Deck/Stairs/Pahos $125 Gazebo(WIStat 59.692(ly)) 5350 0 <br /> Camping Unit $1N Fill $156 <br /> r <br /> Permit Extension Valid for one yew-Only I Allowed $100 R <br /> *NOTE:After-the-fact(when no permit is owned prior to consbuctinn)is three times the normal fee. <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. <br /> *Items not listed abowe will be treated as accesses stnrctme.!�such as:pergolas,/andwy ' retain' walls. <br /> r, <br /> Applicant Complete All Sections Below This Line s <br /> Applicant's Name: <br /> T�7"/4/,E-Q--,( <br /> Applicant's Mailing Address: <br /> /f city State Zip <br /> Q/ .a <br /> e , / c <br /> Applicant's Tel hone Number: <br /> Applicant's Email: S raA 4S P7/ri ��//7 a In <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. Y ^; <br /> b � <br /> ❑better Phone Ef Email N <br /> Legal Description:_ <br /> Lot#: CSM Vol. Pg. OR G <br /> Lot#: Block#:Q,Subdivision Name: r I S O a <br /> Gov't Lot#: OR 1/4 174 <br /> t <br /> Section#: Town#: N Range#: W Town of: <br /> a <br /> 'Attach additional page ifneeded for lengthy description OR anach a copy of the deed OR attach tax system property page.' H <br /> r <br /> 1 <br /> Parcel#(24 digits): J r� <br /> Tax ID#(1-5 digits): <br /> Property Site Address <br /> Road Name: 1 0 6 City: <br /> TY OF PERMIT(S):Check appropriate box/boxes Fee Roe: S lir <br /> Single Family Dwelling Ll Multi-Family Dwelling El Filling/Grading O Commercial MAding <br /> ❑ Single Family Addition ❑ MultrFamily Addition ❑Deck/Mo ❑Commerdal Addition <br /> ❑ Stairs ❑ Acc.StrtxWm(Non-bunkhouse) ❑Bunldtouse ❑Cotrane xial Acc.Stru=re N <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑Ca Uri ❑Commercial Acc.Addition, C <br /> retSaY' rlsji o� v, mil <br /> Proposed Structure/Addition Use:.:& ar- o>7 � Y �� ''Z rri <br /> (HomelCab' CommereW arson Bedroom Drdl. .) <br /> Building Contractor: � c'1, h^ (' p <br /> N <br /> O <br /> Anticipated Start Date: !z. <br /> Page 1 of 4 Z <br /> Burnett County,WI Laud Use Application—Rev 4/2015 C� <br />