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LAND USE PERMIT APPLICATION— Burnett County, WI a <br /> Permit Fees: a to <br /> a <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwellin rinci al Building-Single Family $200 C7 <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwellin rinci al Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 .. <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &Il $200 Addition to Accessory Structure-Commercial CI &II $200 <br /> Deck/Stairs/Patios Z$b,_ $125 Gazebo WI Stat 59.692(lv)) $350 c <br /> Camping Unit $100 Filling/Grading $150 <br /> r "57- <br /> Permit Extension Valid for one year-Only 1 Allowed $100 47AW <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is,&reftmes the normal fee. w <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: er olas, landscaping, retaining walls. <br /> ro <br /> Applicant Complete All Sections Below This Line <br /> Applicant's Name: <br /> Applicant's Mailing Address:-70— � e W <br /> City State zip a <br /> Applicant's Telephone Number: `� !w Gy o <br /> T____��12Q1rt•1. I s <br /> Applicant's Email:�D J? C e b' d <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> Letter OPhone ❑Email N <br /> Legal Description: <br /> Lot#: CSM Vol. Pg. OR d <br /> Lot#: Block#: Subdivision Name: OR � a, <br /> Gov't Lot#: OR 1/4 1/4 �_ j o <br /> 1 0 1 <br /> Section#:�/L Town#: LJ0 N Range#:15� W Town o£ <br /> DAL��'� I <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* H l <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): 3333q <br /> Property Site Address#: / nn/ '' 1 <br /> Road Name: ,QEL�i2 Rd, City: L TbVi�V�4i 2 <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 XDeck/Patio ❑ Commercial Addition ( C <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> ❑ Permit Extension L3 Gazebo-WI Stat 59.692(Sv) 13 Camping Unit Ll Commercial Acc.Addition Z C �i�V�J <br /> C44. 111111 <br /> y � o <br /> Proposed Structure/Addition Use: 4i 1111 y rrrZrrrttt C-) <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ; B U u <br /> Building Contractor: C7 � <br /> Anticipated Start Date: Z <br /> Page /1 of 4 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> b <br /> M <br /> M <br /> M <br />