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LAND USE PERMIT APPLICATION— Burnett County, WI <br /> aa Z <br /> _ <br /> y �0 <br /> Permit Fees: ;' 1 1 I I vt <br /> Dwelling/Principal Building-Single Family $300 Addition to DwellinglPrincipal Building-Single Family $200 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 Z <br /> Commercial/industrial Building $300 Addition to CommerciaVIndustrial Building $200 V% <br /> AccessoryStructure/Addition to Acc.Structure $150 Bunkhouse $250 "I m 1 O <br /> AccessoryStructure-Commercial Cl &11 $200 Addition to AccessoryStructure-Commercial Cl &Il $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(1 v)) $350 <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only1 Allowed) $100 S <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. w <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. 2 <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping,retaining walls. <br /> -o <br /> m <br /> Applicant Complete All Sections Below This Line �. <br /> Applicant's Name: ��Qy I1 /!L �✓USS N ° <br /> Applicant's Mailing Address: L19,3 2`3 12-d Sri• �7�U�f�� ' i't s/1�8L <br /> City State zip <br /> Applicant's Telephone Number: 7 f S� " y —.� �j d^�-/c, �/ �y7�3 03 o H " <br /> .f coin <br /> a <br /> Applicant's Email: dc m, 103(G3 q l�rir� t ^p <br /> d <br /> B <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. I <br /> (� ❑Letter hone mail N a <br /> Legal Description: 1 /V r PG S:z <br /> m <br /> Lot#: CSM Vol. Pg. OR <br /> �• <br /> Lot#: Block#: Subdivision Name: OR „ <br /> Gov't Lot#: OR S G 1/4 S 1/4 F <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): <br /> F z <br /> Tax ID#(1-5 digits): I D)qQ' { <br /> Property Site Address#: 1 Do n �)' y <br /> Road Name: ('_h r / S 7F/71 t - 1�!J City:_ S P O O"t,� <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Redso <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition N <br /> m <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) Ll Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc.Addition z <br /> ` hIdI` n M <br /> Proposed Structure/Addition Use: �! it "' ()U7 L[J� 1 �S � <br /> ( ome/Cabin:Commercial Business:Bedroo ,Deck:etc.) Z N Z m FH <br /> Building Contractor. ihU U 1 " `!r(a tiV d K Z <br /> 21 <br /> Anticipated Start Date: Z 0 0 <br /> Page 1 of 4 c Z `n <br /> Burnett County, WI Land Use Application — Rev 4/2015 4 <br /> 'm <br /> m <br /> A <br /> rn <br />