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LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> y _ 1 <br /> Permit Fees' ti <br /> Dwelling/Principal Building-Sin le Famil $300 Addition to Dwelling/Principal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Fa $300 Addition to Dwelling/Principal Building-Multi-Family $200 v <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 E <br /> AccessoryStructure/Addition to Ace.Structure $150 Bunkhouse $250 I <br /> AccessoryStructure-Commercial(CI &I1) $200 Addition to AccessoryStructure-Commercial Cl &11) $200 <br /> Deck/Stairs/Patios 5 I Gazebo(WI Stat 59.692(l v)) $350 o l <br /> Camping Unit $100 Fillin Gradin $150 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 <br /> 0 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. v <br /> d <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. -' <br /> *Items not listed above will be treated as accessmy structures,such as:pergolas,landscaping,retaining walls. <br /> Applicant Complete All Sections Below This Line c <br /> ! c <br /> Applicant's Name: J q <br /> Applicant's Mailing Address: S S T � o xf �4 <br /> City State Zip o <br /> 'z <br /> Applicant's Telephone Number: �5 ej 17 - -s2 /�y d D �- � 130 o y <br /> a{ <br /> Applicant's Email: �_ K'YZL, w <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> y ❑Letter Phone// r❑Email / o tl0 <br /> Legal Description,40&9G sm t/ �I t l �.t 6t _ B7o1� QQ' Ul <br /> Lot#: CSM Vol. g. OR o <br /> a , <br /> Lot M Block#: Subdivision Name: OR „ <br /> Gov't Lot#: OR 1/4 1/4 1 <br /> 1 <br /> Section#: Town#: N Range#: 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. <br /> Parcel#(24 digits): 4 7_ (73:2 -o7 — q f- )5—.2C—5 D 5- - o 02 d S o 0(a D <br /> Tax ID#(1-5 digits): <br /> Property Site Address#: <br /> Road Name:( I4A, Cit 14 4a L4, 5[/g 30 " I <br /> (� f <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: 4 0 <br /> ❑Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> H <br /> ❑Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 52 <br /> 0 <br /> ❑Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(iv) X Camping Unit ❑ Commercial Acc. Addition <br /> n <br /> Proposed Structure/Addition Use: a Z D <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) -mn O <br /> Building Contractor: z Z r <br /> Anticipated Start Date: -t; <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 4/2015 ; k <br /> b <br /> S <br /> m <br /> z <br /> m <br />