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LAND USE PERMIT APPLICATION— Burnett County, WI g b <br /> Permit Fees: 3 <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwellin rim.,oal Building-Single Family $200 O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Muld-Family $200 v <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 O <br /> Accessory Structure/Addition to Ace.Structure CU50 i Accessory Structure or Bunkhouse $250 t <br /> Accessory Structure-Commercial(C 1 &11) $200 Addition to Accessory Structure-Commercial C 1 &Il <br /> Deck/Stairs/Patios 1 $125 1 Gazebo WI Stat 59.692(1v)) I $350 <br /> < U11 <br /> Camping Unit $100 Filling/Grading $150 <br /> ''ermit Extension Valid for one year-Only 1 Allowed $100 <br /> 0 <br /> *NOTC:After-the-fact(when no permit is obtained prior to construction)is three times the normal <br /> *Communication Towers&Signs require a different application form,see corresponding application and fees. I . <br /> *Items not listed above will be treated as accessory structures,such as:pergolas, landscaping, retaining walls. 2 <br /> �o <br /> A <br /> {� <br /> Applicant Complete All Sections Below This Line o . <br /> Applicant's Name: �y 'A f � <br /> Applicant's Mailing Address: Sob SO ve cn V�-/t,.y ��djG✓� �1y 57s�`Z <br /> C, Cvy State Zip <br /> Applicant's Telephone Number: r� 310 — I /C, �r <br /> Applicant's Email: A?6 '<yC,1A_5 lqL 17L&,tt`I e <br /> a <br /> o J <br /> d <br /> If staff has a question about this application how do you prefer to be contacted? C ,eck one below. <br /> ❑Letter ❑Phone mail o StJ <br /> 0 <br /> Legal Description: <br /> Lot#: 1 CSM Vol.-Pg. 3 OR i <br /> Lot#: Block#: Subdivision Name: { 41 (3 OR <br /> r,,v't Lot#: 3_OR 1/4 1/4 <br /> Section;r: 2 Town#: ya k N Range#._L W Town of: <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system properly page.* H <br /> I � <br /> Parcel#(24 digits): V © � 3©© r Cj� <br /> Tax ID#(1-5 digits): z <br /> � z <br /> Property Site Address#: o( U ( ) <br /> Road Name: &m►` (_Ry- oXe City: {(�(A +'I"-Y <br /> TYPE OF PERMIT(S): Check appropriate box/boxes y Fee Rec: 1-5Dfcc <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 6 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(iv) ❑ Camping Unit ❑ Commercial Acc.Addition C) <br /> y <br /> Proposed Structure/Addition Use: Z <br /> (Home/Cab',Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: ✓1eG I PZ 'i <br /> irk <br /> r� <br /> -_nticipatPd Start Date: a 0 1 C 31gin <br /> Page 1 <br /> Burnett County, WI Land Use Application— Rev 3/20101 5 <br /> En <br />