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LAND USE PERMIT APPLICATION —Burnett County, W1 <br /> Permit Fees: c +jt <br /> g <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwell' rind 1 Building-Single Family $ZOtI <br /> Dwellin='Future Building-Multi-Family 5306 Addition to •'Pring) Building Muni-Family $200 ! n <br /> Commercia4'tndustcial But 5300 Addium w CommacatIodumial Building S200 <br /> ,O <br /> Accessory Stnraure;'Addition to Aa.Structure $150 Bunkhatse g250 � <br /> Accessory Structure-Commercial(C I &11) $200 Addition to Accessory Suucture-Commercial(CI&11) $200 a <br /> Dcck/Stairs/Patios 5125 Gazebo(WI Stat 59-G92(lv)) $350 0 ` <br /> Camping Unit $100 Fillip Gradin 5150 <br /> Permit Extension(Valid W one year-Only I Allowed) $106 <br /> `NOTE:After-the-fact(when no permit is obtained prior to consminion)is time tines the normal fee. � s <br /> 'Communication Towers&Signs require a different application form,see corresponding application and fees. � <br /> 'Items not listed above will be treated as accessa •strictures,such as-pergolas,landscaping,retaining walls. <br /> v <br /> Applies*Complete All Sections Below This Line S � <br /> Applicant's Name: 1 �Sta� --- 0 <br /> _ IT c <br /> A <br /> Applicant's Mailing Address: 7tsi��r r t L'-� <br /> City State Zip <br /> � o <br /> Applicant's Telephone Number:H—L, - /fg- -y o <br /> t <br /> Applicant'sEmail:���/sem, CL <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ro 1 <br /> ❑Letter OPhone XEtnail , <br /> t <br /> Legal Description:_ m. 00 <br /> Loc#: CSi+,1 Vol Pg OR a ,� <br /> Lot#: Block#: _Subdivision Name: OR <br /> Gov't Lot#: OR 1!4 114 � o <br /> Section#:__Town#: N Range#: W Town of is <br /> •Attach additional page ijnecIcet for lengthy description OR attach a copy of the deed OR attach fox system property page.• '� Iry <br /> Parcel#(24 digits): <br /> II <br /> Tax 1D#(1-5 digits): <br /> Property Site Ad Iress <br /> Road Name: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:o�� <br /> U Single Family Dwelling ❑ Multi-Family Dwelling LJFilling/Grading Ll Commercial Building <br /> Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑Commercial Addition <br /> ❑ Stairs ❑ Acc.Structure(Non-bunkhouse) ❑Bwttttwttse ❑Commercial Acc.Structure � <br /> ❑ Permit Exterrsion ❑ Gazebo-WI Stat 59.692(ly) U Camping Unit ❑ Commercial Acc. Addition <br /> Proposed StructurelAdditionUw: r;l,t r- �,� 9f1 brC' -+ C <br /> Womc,'C'abtn;Commercial Busirtess;Bedroom;De(k.etc) T 33 L— <br /> O Z C <br /> Building Contractor:_.-n (� ('�� , - E 1�`,l j �s((.lY l Z r <br /> Anticipated Start Date: Z N <br /> Page 1 of <br /> Burnett County, WI Land Use Application—Rev 4/2015 <br /> j <br />