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LAND USE PERMIT APPLICATION —Burnett County, WI Cr c <br /> rn N+ <br /> Permit Fees: $ to <br /> a <br /> DwellingfPrincipal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> Dwellin rinci al Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaUIndustrial Building $200 O <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial(Cl &11) $200 Addition to Accessory Structure-Commercial Cl&I1) $200 <br /> Deck/Stairs/Patios $125 Gazebo WI Stat 59.692(l v)) $350 c <br /> Camping Unit $100 Filling/Grading $150 <br /> r <br /> Permit Extension(Valid for one year-Onl lAllowed) $100 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. v <br /> d <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 /> Applicant Complete All Sections Below This Line <br /> Applicant's Name: U U InU/I IV ��n�kE1 wA S K1 nF <br /> Applicant's Mailing Address: I 1+�' IMeA IQ 6w 171 o d K C,2Cc1(- Kru tJX II I_ TS I3 I <br /> City State Zip t, <br /> XS Z <br /> Applicant's Telephone Number: Zy <br /> '1 c <br /> 0) a <br /> Applicant's Email: tlp o <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter []Phone ❑Email c oz t <br /> Legal Description: <br /> Lot#: CSM Vol.. Pg. OR o <br /> y <br /> 3. <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR1/4 _1/4 F <br /> _ I a l <br /> Section#: �� Town#: � N Range#:�_W Town oE��+���sl�1 Ir;Y(�^y � `� y <br /> *Attach additional page i needed or lengthy description OR attach a co o the deed OR attach tax system property page. <br /> P ghf f g2 Y P PY f Y P P tYPg <br /> Parcel#(24 digits): U� J�I�-�o�-ai-�I— �(� I pon ,r <br /> II- <br /> Tax ID#(1-5 digits): <br /> Property Site Address#: <br /> Road Name: SZwi, I a City: r <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 ❑ Deck/Patio ❑ Commercial Addition y <br /> ❑ Stairs )(Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure c <br /> NCD <br /> ❑ Permit Extension ❑ Gazebo <br /> -WI Stat 59.692(ly) ❑ Camping Unit ❑ Commercial Acc. Addition C = <br /> Proposed Structure/Addition Use: `O/1V)1,-c4 j' Z v <br /> (Home/Cabin;Commercial Business:Bedroom;Deck;etc.) <br /> Building Contractor: W�I hI b NNS.d A) 0 <br /> O _o <br /> Anticipated Start Date: — 1 I} —I> Z v <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> ro <br /> z <br /> M <br /> 9 <br />