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LAND USE PERMIT APPLICATION —Burnett County, WI P <br /> a <br /> m` y <br /> Permit Fees: <br /> ii <br /> Dwelling/Principal Building-Sin le Family $300 Addition to DwellingfPrincipal Building-Sin le Family $200 o <br /> Dwelling/Principal Building-Multi-Family $300 Addition to DwellingtPrincipal Building-Multi-Family $200 g <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 l £O <br /> Accessory Structure-Commercial CI &II $200 Addition to Accessory Structure-Commercial Cl &11) $200 <br /> Deck/Stairs/Patios $125 Gazebo(WT Stat 59.692(l v)) <br /> Camping Unit $100 Filling/Grading $1 ` <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. <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 �. <br /> // z <br /> Applicant's Name: 5 i 6.9 A/ 7g yL A N L) C <br /> Applicant's Mailing Address: --,,) 7$6 9 7-J,6 "St Illq yF1640 A)Irl <br /> City State zip <br /> _ 3 <br /> Applicant's Telephone Number: j U ' 366 '8930 c � <br /> — c <br /> a <br /> Applicant's Email: h u I4 rl al G K tri fe U m o <br /> B <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter ❑Phone [Email N °° <br /> Legal Description: <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR r„ <br /> i31 <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: (I 1-3° <br /> *Attach additional page if neededfor lengthy description OR attach a copy of the deed OR attach tax system propertyPaBe. <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): ' " <br /> Property Site 6 Address#: <br /> Road Name: \./ L- C,0o�S Kr City: wc�A�e <br /> TYPE OF PERMIT(S): 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 6 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition Z <br /> C, <br /> � <br /> n <br /> Proposed Structure/Addition Use: j>Ct f/U Gtr L cc 9N m <br /> 70 <br /> (Home/Cabin:Commercial Business:Bedroom:Deck:etc.) o�ZU"��ili 0." <br /> Building Contractor: `— C �Y> O 0 <br /> Anticipated Start Date: - <br /> Pagel 4 <br /> Burnett County, WI Land Use Application—Rev 1/200 16 <br /> m <br />