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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> a <br /> <' b <br /> Permit Fees: ; on ON <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 C7 <br /> Dwelling/Principal Building-Multi-Famil $300 Addition to Dwelling/Principal Building-Multi-Famil $200 <br /> ic. <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> O <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &Il $200 Addition to Accessory Structure-Commercial Cl &Il) $200 'V <br /> Dec Patios 14110 k Gazebo WI Stat 59.692(l v)) $350 0 <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-01,dy l Allowed) $100 <br /> 0 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. <br /> 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 /> m <br /> Applicant Complete All Sections Below This Line <br /> Z <br /> /� C,I <br /> Applicant's Name: y/► t cA e- ) 6 tA-&A Sj o f-p 1 P <br /> Applicant's Mailing Address: /[)3 tel/ /�110�G /C G� 2un6%Ay V WT <br /> City State Zip ni ro <br /> Applicant's Telephone Number: 7/J' <br /> a <br /> Applicant's Email: MX J Anj rn%,�e f0✓ C_p,,, <br /> d <br /> m <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter ❑Phone EEmail N w <br /> Legal Description: t <br /> Lot#: [ CSM Vol. Aa 9. /7 OR t? <br /> 5. <br /> Lot#: Block#: Subdivision Name: OR r„ � <br /> Gov't Lot#: OR 1/4 1/4 )j f <br /> Section#: Town#: <br /> __Y6 N Range#:.___[7—W Town of: pyy <br /> H l <br /> *Attach additional page ijneeded for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> 1 <br /> Parcel#(24 digits): C�7' b3�'�?-yG'/) — 36 - 4 Uy - Coo - a bacwj � <br /> Tax ID#(1-5 digits): d z <br /> Property Site Address#: ,o 3 g/ <br /> Road Name: ,c]4 r+ City: c.n �•,t.r V <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:Las.—Clu <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition <br /> 2C <br /> * <br /> Proposed Structure/Addition Use: e-a n <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) m -< g <br /> ) boC:)Building Contractor: Hf,�✓ /p o �u <br /> N <br /> Anticipated Start Date: (s (j/ V <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 1/2016 <br /> m <br /> m <br />