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LAND USE PERMIT APPLICATION — Burnett Countv. WI f~ <br /> H <br /> Permit Fees: ° fit <br /> a <br /> Dwellin rinci al Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 O <br /> Dwelling/Principal Building-Multi-Family $300 Addition to Dwelling/Principal Building-Multi-Family $200 <br /> m <br /> Commercial/Industrial Building $300 Addition to Commercial/Industrial Building $200 <br /> Accessory Structure/Addition to Acc.Structure $150 Bunkhouse $250 <br /> Accessory Structure-Commercial Cl &11) $200 Addition to Accessory Structure-Commercial Cl &11) $200 't <br /> Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(lv)) $350 0 <br /> Camping Unit $100 Filling/Grading $150 C6 <br /> Permit Extension Valid for one year-Only 1 Allowed $100 <br /> o <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. m �' <br /> v <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. Q <br /> -o <br /> Applicant Complete All Sections Below This Line <br /> z <br /> 0 <br /> Applicant's Name: 7re_ki t,r VGYt S / <br /> Applicant's Mailing Address: �3�9 y �A yq e 15Zjee-kt Lar 64 87 <br /> City State Zip <br /> � z <br /> Applicant's Telephone Number: 7/S-do,7 b - 3.2A S o y '� <br /> Applicant's Email: b re-K,•t, 44 cz wtwrL <br /> r <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> Qj <br /> []Letter Phone ❑Email o w <br /> Legal Description: 5.2 7 %3rN /7!•J <br /> Lot#: / CSM Vol. Pg. d2/�2 OR 1 <br /> Lot#: Block#: Subdivision Name: OR <br /> 1 <br /> Gov't Lot#: OR 1/4 1/4 SO <br /> Section#: Town#: N Range#: W Town of: 31) o <br /> *Attach additional page ifneededIor lengthy description OR attach a copy of the deed OR attach tar system propertyPage. <br /> X11"" <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): 3.3 SS,�_ z <br /> y � _ <br /> Property Site Address#: a2,30 q e) <br /> Road Name: OLCity: ,5*,'✓evt 5^118262 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec:�c1(/eC�j� <br /> Single Family Dwelling ❑ Multi Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition y <br /> 0 <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure N <br /> 13Permit Extension L3Gazebo-WI Stat 59.692(iv) ElCamping Unit 13Commercial Acc. Addition ? x["'71 <br /> Z <br /> �`."J <br /> n <br /> Proposed Structure/AdditionUse: u1Slt Gt�r_aE /Zto�ICc l�yit�e > <br /> (Home/Cabin;Commercial Business;Bedroom:Deck;etc.) , <br /> t1 <br /> Building Contractor: crt <br /> N <br /> Anticipated Start Date: o <br /> Page 1 of 4 0 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br /> m <br /> m <br />