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LAND USE PERMIT APPLICATION—Burnett County, WI <br /> h <br /> Permit Fees: <br /> DwellingfPrincipal Building-Single Family $300 Addition to Dwelling/Principal Building-Single Family 5200 = Q <br /> DwellingTrincipal Building-Multi-Family $300 Addition to DwellingfPrincipal Building-Multi-Family $200 <br /> Commercial/Industrial Building $300 Addition to CommerciaUIndustrial Building $200 C <br /> Accessory Structure/Addition to Ace.Structure $150 Bunkhouse $250 _ e <br /> Accessory Structure-Commercial(CI&11) $200 Addition to Accessory Structure-Commercial Cl&Il) $200 <br /> Dec tairs/Patios $125 1 Gazebo(WI Stat 59.692(lv)) $350 <br /> am in Unit $100 Filling/Grading $t50 <br /> r <br /> Permit Extension(Valid for one year-Only 1 Allowed) $t00 <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:pergolax,landscaping,retainingIts. <br /> v <br /> rn <br /> 0 1 <br /> z <br /> Applicant's Name: J <br /> Applicant's Mailing Address: aV MN <br /> City State Zip c — <br /> � � a <br /> Applicant's Telephone Number: � d <br /> Applicant's Email: 'C CQYY\ p O <br /> �zSul <br /> If staff has a question about this application how do you prefer to be contact(. Check one below. <br /> ❑ <br /> ,ppm�tt,� Letter Phone ❑Email I <br /> K- c <br /> Legal Description: OU <br /> Lot#: CSM Vol Pg. OR t7 <br /> R <br /> Lot#: Block#: Subdivision Name: OR R m <br /> Gov't Lot#: OR 1/4 1/4 <br /> Section#: Town#: N Range#: W Town of: 1 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage.* y <br /> Parcel#(24 digits): r, <br /> Tax ID#(1-5 digits): n z <br /> Q � x <br /> Property Site AAddress#: ! C <br /> Road Name: 1 a-rk St <br /> City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes Fee Rec laSrQ� <br /> ❑ Single Family Dwelling ❑ Multi-Family Dwelling ❑, Fulling/Grading ❑Commercial Building <br /> flr <br /> ❑ Single Family Addition ❑ Multi-Family Addition uec Patio ❑Commercial Addition <br /> ❑ Stairs ❑ Acc. Structure(Non-bunkhouse) ❑ Bunkhouse ❑Commercial Acc. Structure <br /> ❑ Permit Extension ❑ Gazebo—WI Stat 59.692(ly) ❑ Camping Unit ❑Commercial Acc.Addition <br /> Proposed Structure/Addition Use: Cub tr' <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Building Contractor: x�� <br /> Anticipated Start Date: PS'sP�CJ <br /> Page 1 of 4 <br /> Burnett County,WI Land Use Application—Rev 4/2015 <br />