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LAND USE PERMIT APPLICATION— Burnett County WI a 1 C <br /> Permit Fees: s <br /> Dwelling/Principal Building-Sin le Family $300 Addition to Dwellin rinci al Building-Sin le Family $200 <br /> v �Q <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwellin rinci al Building-Multi-Family $200 y, <br /> Commercial/Industrial Building 5300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial CI &II) $200 Addition to AccessoryStructure-Commercial Cl &11) $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat59.692lvp $350 0 1 <br /> o _ <br /> Camping Unit $100 Filling/Grading $150 <br /> Permit Extension Valid for one year-Only 1 Allowed) $100 o <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. o <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 /> m <br /> Applicant Complete All Sections Below This Line <br /> Applicant's Name: e 22 // $0q t/ <br /> Applicant's Mailing Address: 3(x& ata e- /VGA s AV <br /> City State zip �n <br /> Applicant's Telephone Number: - c � � <br /> SJ9 <br /> Applicant's Email: V <br /> i o <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. 1 <br /> ❑Letter ®Phone Email N <br /> Legal Description: S� /9-T!'AGLj�p D u-•-LENT <br /> rA <br /> Lot#: CSM Vol. Pg. OR o 1 <br /> n' V <br /> Lot#: Block#: Subdivision Name: OR o, 1 <br /> Gov't Lot#: OR 1/4 1/4 <br /> 1� E <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 tar system property page.* ) <br /> Parcel#(24 digits): <br /> F <br /> m <br /> Tax ID#(1-5 digits): n z <br /> Property Site Address#: 130 �n y <br /> Road Name: Cp Hn/1--y City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec <br /> 13Single Family Dwelling E3 Multi-Family Dwelling L3Filling/Grading El Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse et Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo–WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition z WQ <br /> p n C <br /> Proposed Structure/AdditionUse: �TpQ.46rF l�y�i ,pin/ Z C <br /> / (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Q Z <br /> Building Contractor: TL°.2e,7AM +� t <br /> 2 0 <br /> Anticipated Start Date: � 00 2 <br /> Page 1 4 <br /> Burnett County,WI Land Use Application—Rev 4/200 15 <br /> F <br />