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r r <br /> LAND USE PERMIT APPLICATION —Burnett Coun e <br /> 7 <br /> a <br /> C7 <br /> Permit Fees: w <br /> Dwellin /Princi al Buildin -Sin le Famil $300 Addition to Dwellin /Princi al Buildin -Sin le Famil $ZO � <br /> Dwellin /Princi al Buildin -Multi-Famil $300 Addition to Dwellin rinci al Buildin -Multi-Famil $200 O <br /> $300 Addition to Comm erciaVlndustrial Buildin <br /> Commercial/Industrial Buildin $250 1 <br /> Accesso Structure/Addition to Ace.Structure <br /> $150 Bunkhouse <br /> $200 Addition to Accesso Structure-Commercial Cl &Il $20 <br /> Accesso Structure-Commercial(Cl &Il) Stat 59.692(lv)) $350 0 <br /> Deck/Stairs/Patios $125 Gazebo(WI $150 <br /> $100 Fillin /Grading r <br /> 0 <br /> Cam in Unit - <br /> Permit Extension olid for one ear-Onl I Allowed $100 <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 <br /> esso structures,such as: er olas, landsca in ,retainin walls. c <br /> *Items not listed above will be treated as ace <br /> 3 <br /> r _ <br /> Applicant Complete All Sections Below This Line ° z <br /> 0 <br /> Applicant's Name: t« <br /> Gq�0� �1ati'L � -yoic . V�lQ,lofs�l�/ yV� 9�g°I3 <br /> p Applicant's Mailing Address: Cit, State Zip <br /> 2 <br /> Applicant's Telephone Number: <br /> Applicant's Email: C we �,�Ml►+�• Ct�r` O <br /> w <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter aa Phone ❑Email o <br /> Legal Description: CSYV\ :0-3�1AO ) (Gov Ur a. U 3°11°101 a <br /> ao <br /> Lot#: _CSM Vol. 00 g. $1 OR <br /> 3. <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#:�^OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: SW 1 cc, <br /> i <br /> *Attach additional page i needed or lengthy description OR attach a co o the deed OR attach tax stem ro er a e. <br /> P 8 f f 8 Y P PY f system P P IYP 8 <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): OV <br /> N � V <br /> Property Site Address#: 3J6 y A <br /> Road Names{ L'L Dr City: Qq kbwr) (J 1 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building Fee Rec: ` , t <br /> ❑ Single Family Addition ❑ Multi-Family Addition peck/Patio ❑ Commercial Addition <br /> ❑ Stairs X Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N r--- <br /> ❑ Permit Extension LlGazebo—WI Stat 59.692(ly) ❑ Camping Unit LlCommercial Acc.Addition z <br /> Proposed Structure/Addition Use: ayd Id Yh Q11W&ft9(�� <br /> (Nome/Cabin;CommercialBusiness;Bedroom; eck;etc.)�,/, y� � (� '>"lt +��► 1. <br /> Building Contractor: N 11A <br /> Anticipated Start Dater wet <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 1/2016 <br /> b <br /> r� <br /> M <br />