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LAND USE PERMIT APPLICATION — Burnett County, WI y r <br /> y• ^ <br /> Permit Fees: <br /> Dwelling/Principal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family $200 1Z c A3 <br /> d <br /> Dwellin rind al Building-Multi-Famil $300 Addition to Dwelling/Principal Building-Multi-Famil $200 <br /> 4� � <br /> Commercial/Industrial Buildin $ Addition to CommerciaVIndustrial Buildin $200Accesso Structure/Addition to Acc.Structure $150 Bunkhouse $250Accesso Structure-Commercial Cl &I1) $200 Addition to Accesso Structure-Commercial Cl &Il) $200 Deck/Stairs/Patios $125 Gazebo(WI Stat 59.692(1 v)) $350 <br /> Camping Unit $100 Filling/Grading $150 < <br /> Permit Extension Valid for one ear-Only1 Allowed $100 0 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. <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 /> -o <br /> Applicant Complete All Se ti Below This Line c . <br /> Z <br /> Applicant's Name: 00 <br /> 0 <br /> S�F83o <br /> 40 Ill. <br /> Applicant's Mailing Address: kiL <br /> Ci State zip b <br /> Applicant's Telephone Number: 7/ <br /> a <br /> Applicant's Email: O <br /> w <br /> n <br /> If staff has a question about this application how do you refer to be contacted? Check one below. <br /> Letter Phone ❑Email o AJ <br /> Legal Description: 77-,2 <br /> Lot#: CSM Vol. Pg. OR o <br /> N r, <br /> ti xJ <br /> Lot#: Block#: Subdivision Name: OR1- <br /> Gov't Lot#: OR 1/4 1/4 F <br /> Section#: 2--2- Town#: �N Range#:A— Town of: ( �Q'n 4 J` <br /> r y 1 <br /> *Attach additional page if need// /ettd��fo�r7lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> Parcel#(24 digits): -OLD 2- - y0 � A -Z-2- ' 7, � G� <br /> V <br /> Tax ID#(1-5 digits): 131. 2- <br /> Property <br /> Property Site Address#: 7mg ll <br /> Road Name: C pPN 4 C_ City: AA 11 U yr <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec: m ,m <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑ Filling/Grading ❑ Commercial Building <br /> ❑ Single Family Addition ❑ Multi-Family Addition ❑ Deck/Patio ❑ Commercial Addition 14 <br /> 0 <br /> ❑ Stairs Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑ Commercial Acc. Structure m <br /> ❑ Permit Extension ❑ Gazebo-WI Stat 59.692(Sv) ❑ Camping Unit ❑ Commercial Acc.Addition co <br /> Proposed Structure/Addition Use: .> Z C <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ,y, r— <br /> dV <br /> Building Contractor: _ o <br /> Anticipated Start Date: m ; <br /> Page 1 of 4 c ( IJ tt u <br /> Burnett County,WI Land Use Application—Rev 4/2015 > n <br /> F <br /> c <br />